Woodmass Jarret M, Esposito John G, Ono Yohei, Nelson Atiba A, Boorman Richard S, Thornton Gail M, Lo Ian Ky
Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.
Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada ; Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Open Access J Sports Med. 2015 Apr 10;6:97-107. doi: 10.2147/OAJSM.S73211. eCollection 2015.
Over the past decade, a number of arthroscopic or arthroscopically assisted reconstruction techniques have emerged for the management of acromioclavicular (AC) separations. These techniques provide the advantage of superior visualization of the base of the coracoid, less soft tissue dissection, and smaller incisions. While these techniques have been reported to provide excellent functional results with minimal complications, discrepancies exist within the literature. This systematic review aims to assess the rate of complications following these procedures.
Two independent reviewers completed a search of Medline, Embase, PubMed, and the Cochrane Library entries up to December 2013. The terms "Acromioclavicular Joint (MeSH)" OR "acromioclavicular* (text)" OR "coracoclavicular* (text)" AND "Arthroscopy (MeSH)" OR "Arthroscop* (text)" were used. Pooled estimates and 95% confidence intervals were calculated assuming a random-effects model. Statistical heterogeneity was quantified using the I(2) statistic.
IV.
A total of 972 abstracts met the search criteria. After removal of duplicates and assessment of inclusion/exclusion criteria, 12 articles were selected for data extraction. The rate of superficial infection was 3.8% and residual shoulder/AC pain or hardware irritation occurred at a rate of 26.7%. The rate of coracoid/clavicle fracture was 5.3% and occurred most commonly with techniques utilizing bony tunnels. Loss of AC joint reduction occurred in 26.8% of patients.
Arthroscopic AC reconstruction techniques carry a distinct complication profile. The TightRope/Endobutton techniques, when performed acutely, provide good radiographic outcomes at the expense of hardware irritation. In contrast, graft reconstructions in patients with chronic AC separations demonstrated a high risk for loss of reduction. Fractures of the coracoid/clavicle remain a significant complication occurring predominately with techniques utilizing bony tunnels.
在过去十年中，出现了多种用于治疗肩锁关节（AC）分离的关节镜或关节镜辅助重建技术。这些技术具有能更好地观察喙突基部、减少软组织解剖以及切口更小的优势。虽然据报道这些技术能产生极佳的功能效果且并发症极少，但文献中仍存在差异。本系统评价旨在评估这些手术的并发症发生率。
两名独立的评审员对截至2013年12月的Medline、Embase、PubMed和Cochrane图书馆条目进行了检索。使用了“肩锁关节（医学主题词）”或“肩锁*（文本）”或“喙锁*（文本）”以及“关节镜检查（医学主题词）”或“关节镜*（文本）”等检索词。假设采用随机效应模型计算合并估计值和95%置信区间。使用I(2)统计量对统计异质性进行量化。
IV级。
共有972篇摘要符合检索标准。在去除重复项并评估纳入/排除标准后，选择了12篇文章进行数据提取。浅表感染率为3.8%，残留肩部/AC疼痛或硬件刺激发生率为26.7%。喙突/锁骨骨折率为5.3%，最常发生于使用骨隧道的技术中。26.8%的患者出现AC关节复位丢失。
关节镜下AC重建技术具有独特的并发症特征。TightRope/Endobutton技术在急性情况下进行时，能提供良好的影像学结果，但代价是硬件刺激。相比之下，慢性AC分离患者的移植物重建显示出复位丢失的高风险。喙突/锁骨骨折仍然是一种主要与使用骨隧道的技术相关的重大并发症。
