Warth Ryan J, Lee Jared T, Campbell Kevin J, Millett Peter J
Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
Steadman Philippon Research Institute, Vail, Colorado, U.S.A ; The Steadman Clinic, Vail, Colorado, U.S.A.
Arthrosc Tech. 2014 Feb 16;3(1):e165-73. doi: 10.1016/j.eats.2013.09.019. eCollection 2014 Feb.
Open resection arthroplasty of the sternoclavicular (SC) joint has historically provided good long-term results in patients with symptomatic osteoarthritis of the SC joint. However, the procedure is rarely performed because of the risk of injury to vital mediastinal structures and concern regarding postoperative joint instability. Arthroscopic decompression of the SC joint has therefore emerged as a potential treatment option because of many recognized advantages including minimal tissue dissection, maintenance of joint stability, avoidance of posterior SC joint dissection, expeditious recovery, and improved cosmesis. There are, however, safety concerns given the proximity of neurovascular structures. In this article we demonstrate a technique for arthroscopic SC joint resection arthroplasty in a 26-year-old active man with bilateral, painful, idiopathic degenerative SC joint osteoarthritis. This case also highlights the pearls and pitfalls of arthroscopic resection arthroplasty for the SC joint. There were no perioperative complications. Four months postoperatively, the patient had returned to full activities, including weightlifting, without pain or evidence of SC joint instability. One year postoperatively, the patient showed substantial improvements in the American Shoulder and Elbow Surgeons score; Single Assessment Numeric Evaluation score; Quick Disabilities of the Arm, Shoulder and Hand score; and Short Form 12 Physical Component Summary score over preoperative baseline values.
历史上，胸锁关节开放性切除关节成形术对于有症状的胸锁关节骨关节炎患者能带来良好的长期效果。然而，由于存在损伤重要纵隔结构的风险以及对术后关节不稳定的担忧，该手术很少实施。因此，胸锁关节镜下减压术作为一种潜在的治疗选择应运而生，因为它具有许多公认的优点，包括组织解剖最少、维持关节稳定性、避免胸锁关节后方解剖、恢复迅速以及美容效果更佳。然而，鉴于神经血管结构位置临近，存在安全方面的顾虑。在本文中，我们展示了一种针对一名26岁活跃男性双侧疼痛性特发性退行性胸锁关节骨关节炎患者的关节镜下胸锁关节切除关节成形术技术。该病例还突出了胸锁关节镜下切除关节成形术的要点与陷阱。围手术期无并发症发生。术后四个月，患者已恢复全部活动，包括举重，且无疼痛或胸锁关节不稳定迹象。术后一年，患者在美国肩肘外科医生评分、单项评估数值评定评分、上肢、肩部和手部快速残疾评分以及简明健康调查简表12身体成分汇总评分方面较术前基线值有显著改善。
