Beitzel K, Mazzocca A D
Abteilung für Trauma und Orthopädische Chirurgie, Berufsgenossenschaftliche Unfallklinik, Prof.-Küntscher-Str. 8, 82418, Murnau am Staffelsee, Deutschland,
Oper Orthop Traumatol. 2014 Jun;26(3):237-44. doi: 10.1007/s00064-013-0277-9. Epub 2014 Jun 14.
The aim of open anatomic reconstruction of the acromioclavicular (AC) joint is combined reconstruction of the AC and coracoclavicular ligaments using a tendon graft.
Symptomatic instabilities of the AC joint > type III.
Asymptomatic instabilities < type III and general contraindication against elective surgery.
Through the open surgical approach, the exact anatomical insertion sites of the ligamentous structures can be reproduced. In addition, this approach enables accurate repositioning of the AC joint under direct vision (including possible debridement of the intraarticular discus) and an additional fixation of deltotrapezoidal fascia.
Postoperatively, the arm is positioned in an abduction brace for 6-8 weeks. Passive exercises in flexion up to 90° and in external rotation up to 30° are permitted during this period. After 6-8 weeks, free and active motion is allowed.
Between January 2003 and December 2010, 46 patients (9 women and 37 men, mean age 42 ± 13 years) underwent AC combined reconstruction. Complete outcome data were available for 25 patients. Mean length of follow-up was 31 ± 26 months. The mean preoperative coracoclavicular distance was 20.1 ± 5.6 mm; postoperatively the mean distance was 7.1 ± 3.0 mm (p < 0.001) The mean clinical scores also statistically improved (p < 0.001): American Shoulder and Elbow Score improved from 53.4 ± 18.7 points preoperatively to 80.6 ± 25.7 points postoperatively and the Constant Murley Score improved from 60.0 ± 16.7 points preoperatively to 85.2 ± 22.8 points postoperatively.
肩锁关节开放解剖重建的目的是使用肌腱移植物对肩锁韧带和喙锁韧带进行联合重建。
Ⅲ型以上有症状的肩锁关节不稳。
Ⅲ型以下无症状的不稳以及择期手术的一般禁忌证。
通过开放手术入路，可以重现韧带结构的确切解剖附着点。此外，该方法能够在直视下准确复位肩锁关节（包括可能对关节内盘状软骨进行清创）并额外固定三角肌斜方肌筋膜。
术后，手臂置于外展支具中6 - 8周。在此期间允许进行屈曲至90°和外旋至30°的被动锻炼。6 - 8周后，允许自由主动活动。
2003年1月至2010年12月，46例患者（9例女性，37例男性，平均年龄42±13岁）接受了肩锁关节联合重建。25例患者有完整的结果数据。平均随访时间为31±26个月。术前平均喙锁距离为20.1±5.6mm；术后平均距离为7.1±3.0mm（p<0.001）。平均临床评分也有统计学改善（p<0.001）：美国肩肘评分从术前的53.4±18.7分提高到术后的80.6±25.7分，Constant Murley评分从术前的60.0±16.7分提高到术后的85.2±22.8分。
