Lenz R, Kreuz P C, Tischer T
Sektion Sportorthopädie und Prävention, Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberanerstr. 142, 18057, Rostock, Deutschland.
Oper Orthop Traumatol. 2014 Jun;26(3):245-53. doi: 10.1007/s00064-013-0279-7. Epub 2014 Jun 14.
Arthroscopic resection of the painful and degenerative altered acromioclavicular (AC) joint without destabilization of the joint and therefore pain relief and improvement in function.
Conservative failed therapy of painful AC joint osteoarthritis. Impingement caused by caudal AC joint osteophytes. Lateral clavicular osteolysis.
General contraindications (infection, local tumor, coagulation disorders), higher grade instability of the AC joint (resection only together with stabilization).
Diagnostic glenohumeral arthroscopy. Treatment of accompanying lesions (subacromial impingement, rotator cuff, long head of biceps). Subacromial arthroscopy with bursectomy (partial) and visualization of the AC joint. Resection of caudal osteophytes. Localization of the anterior portal using a spinal needle in the outside-in technique. Resection of 2-3 mm of the acromial side and the 3-4 mm of the clavicular side with shaver/acromionizer.
An isolated open AC joint resection was performed in 9 studies and an arthroscopic resection in 6 studies. Good and very good results were obtained in 79% (range 54-100%) in open resection and 91% (range 85-100%) in arthroscopic resections. Patients were able to return to activities of daily life more quickly after arthroscopic resections than after open surgery.
在不使肩锁（AC）关节失稳的情况下，通过关节镜切除疼痛和退变的AC关节，从而缓解疼痛并改善功能。
疼痛性AC关节骨关节炎保守治疗失败。AC关节尾侧骨赘引起的撞击。锁骨外侧骨溶解。
一般禁忌症（感染、局部肿瘤、凝血障碍），AC关节较高程度的不稳定（仅在稳定的同时进行切除）。
诊断性肩关节镜检查。治疗伴随病变（肩峰下撞击、肩袖、肱二头肌长头）。肩峰下关节镜检查并进行（部分）滑囊切除术以及观察AC关节。切除尾侧骨赘。采用由外向内技术用脊椎穿刺针定位前侧入路。用刨削器/肩峰切除器切除肩峰侧2 - 3毫米和锁骨侧3 - 4毫米。
9项研究进行了单纯开放性AC关节切除术，6项研究进行了关节镜切除术。开放性切除的优良率为79%（范围54 - 100%），关节镜切除的优良率为91%（范围85 - 100%）。与开放手术相比，关节镜切除术后患者能够更快地恢复日常生活活动。
