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改良韦弗-邓恩手术与使用合成韧带进行肩锁关节重建的比较

Modified Weaver-Dunn procedure versus the use of a synthetic ligament for acromioclavicular joint reconstruction.

作者信息

Kumar Vinod, Garg Sunil, Elzein IhabI, Lawrence Tom, Manning Paul, Wallace W Angus

机构信息

Nottingham Shoulder and Elbow Unit, Nottingham University Hospitals NHS Trust, United Kingdom.

出版信息

J Orthop Surg (Hong Kong). 2014 Aug;22(2):199-203. doi: 10.1177/230949901402200217.

Abstract

PURPOSE. To compare the subjective outcome of acromioclavicular joint (ACJ) reconstruction using the modified Weaver-Dunn procedure versus the Surgilig synthetic ligament. METHODS. 55 patients aged 19 to 72 (mean, 42) years underwent ACJ reconstruction of Rockwood grade 3 (n=38), grade 4 (n=8), and grade 5 (n=9) using the modified Weaver-Dunn procedure (n=31) or the Surgilig synthetic ligament (n=24), based on the surgeon's preference. The mean period from injury to surgical treatment was 39 months. Subjective outcomes were assessed before and after surgery using the Oxford Shoulder score and Nottingham Clavicle score. The time required to return to work and sports was also recorded. RESULTS. After a mean follow-up period of 40 months, the mean Oxford Shoulder scores improved from 28 to 42 in the Weaver-Dunn group (p=0.009), and from 26 to 45 in the Surgilig group (p=0.007), whereas the respective mean Nottingham Clavicle scores improved from 53 to 81 (p=0.047) and from 51 to 93 (p=0.023). The Surgilig group achieved significantly better postoperative Oxford Shoulder score (p=0.008) and Nottingham Clavicle score (p=0.007), and could also return to work (14 vs. 6 weeks, p<0.001) and sports (25 vs. 12 weeks, p<0.001) sooner than the Weaver-Dunn group. Three patients in the Weaver- Dunn group and one patient in the Surgilig group had persistent pain and/or functional deficit with evidence of ACJ dislocation. CONCLUSION. Chronic ACJ reconstruction using the Surgilig synthetic ligament achieved better Oxford Shoulder score and Nottingham Clavicle score and earlier return to work and sports, compared with the modified Weaver-Dunn procedure.

摘要

目的。比较采用改良Weaver-Dunn手术与Surgilig合成韧带重建肩锁关节(ACJ)的主观疗效。方法。55例年龄在19至72岁(平均42岁)的患者接受了Rockwood 3级(n = 38)、4级(n = 8)和5级(n = 9)的ACJ重建,根据外科医生的偏好,采用改良Weaver-Dunn手术(n = 31)或Surgilig合成韧带(n = 24)。从受伤到手术治疗的平均时间为39个月。使用牛津肩部评分和诺丁汉锁骨评分在手术前后评估主观疗效。还记录了恢复工作和运动所需的时间。结果。平均随访40个月后,Weaver-Dunn组的平均牛津肩部评分从28分提高到42分(p = 0.009),Surgilig组从26分提高到45分(p = 0.007),而各自的平均诺丁汉锁骨评分从53分提高到81分(p = 0.047)和从51分提高到93分(p = 0.023)。Surgilig组术后的牛津肩部评分(p = 0.008)和诺丁汉锁骨评分(p = 0.007)明显更好,并且比Weaver-Dunn组更早恢复工作(14周对6周,p < 0.001)和运动(25周对12周,p < 0.001)。Weaver-Dunn组有3例患者和Surgilig组有1例患者存在持续性疼痛和/或功能缺陷,并有ACJ脱位的证据。结论。与改良Weaver-Dunn手术相比,使用Surgilig合成韧带进行慢性ACJ重建可获得更好的牛津肩部评分和诺丁汉锁骨评分,并更早恢复工作和运动。

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