Millett Peter J, Horan Marilee P, Warth Ryan J
Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A..
Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
Arthroscopy. 2015 Oct;31(10):1962-73. doi: 10.1016/j.arthro.2015.03.034. Epub 2015 May 19.
The purpose of this study was to report the clinical and structural outcomes after anatomic coracoclavicular ligament reconstruction (ACCR) with free tendon allografts in patients with grade III and grade V acromioclavicular (AC) joint dislocations.
Thirty-one shoulders underwent primary ACCR with tendon allografts for Rockwood grade III and grade V AC joint dislocations. Preoperative data included patient demographic characteristics, injury characteristics, and surgical history, along with American Shoulder and Elbow Surgeons (ASES) scores, Short Form 12 Physical Component Summary (SF-12 PCS) scores, and various pain scales. Outcome measures were also collected a minimum of 2 years postoperatively with the addition of Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores; Single Assessment Numeric Evaluation (SANE) scores; and patient satisfaction. In addition, preoperative and postoperative coracoclavicular distances were analyzed using standard anteroposterior radiographs.
ACCR was performed in 31 patients (31 shoulders) with a mean age of 43.9 years (range, 21 to 71 years). In 7 patients (22.6%) a complication occurred that required a subsequent surgical procedure including graft rupture/attenuation (2), clavicle fractures (2), distal clavicle hypertrophy (2), and adhesive capsulitis (1). Of the remaining 24 patients, 20 (83.3%) had subjective outcome data available after a minimum 2-year follow-up period (mean, 3.5 years; range, 2.0 to 6.2 years). The mean postoperative ASES and SF-12 PCS scores significantly improved when compared with the preoperative baseline values (58.9 v 93.8 for ASES scores [P < .001] and 45.3 v 54.4 for SF-12 PCS scores [P = .007]). At final follow-up, the SANE and QuickDASH scores were 89.1 and 5.6, respectively, with a median patient satisfaction rating of 9 of 10.
Patients who did not require revision surgery showed excellent postoperative outcome scores: The mean ASES score was 93.8, the mean SANE score was 89.1, and the mean QuickDASH score was 5.6, with a median patient satisfaction rating of 9 of 10. Further study regarding ACCR techniques should focus on decreasing the risks of complications and maintaining reduction of the AC joint.
Level IV, therapeutic case series.
本研究旨在报告采用游离肌腱同种异体移植进行解剖学喙锁韧带重建（ACCR）治疗Ⅲ级和Ⅴ级肩锁关节（AC）脱位患者后的临床和结构结果。
31例肩部因RockwoodⅢ级和Ⅴ级AC关节脱位接受了初次ACCR肌腱同种异体移植。术前数据包括患者人口统计学特征、损伤特征和手术史，以及美国肩肘外科医师协会（ASES）评分、简短健康调查12项身体成分总结（SF-12 PCS）评分和各种疼痛量表。术后至少2年还收集了结果指标，增加了手臂、肩部和手部快速残疾评定量表（QuickDASH）评分、单项评估数字评价（SANE）评分和患者满意度。此外，使用标准前后位X线片分析术前和术后的喙锁距离。
31例患者（31个肩部）接受了ACCR，平均年龄43.9岁（范围21至71岁）。7例患者（22.6%）发生了需要后续手术的并发症，包括移植物破裂/变薄（2例）、锁骨骨折（2例）、锁骨远端肥大（2例）和粘连性关节囊炎（1例）。其余24例患者中，20例（83.3%）在至少2年的随访期（平均3.5年；范围2.0至6.2年）后有主观结果数据。与术前基线值相比，术后ASES和SF-12 PCS平均评分显著改善（ASES评分：58.9对93.8 [P <.001]；SF-12 PCS评分：45.3对54.4 [P =.007]）。在最终随访时，SANE和QuickDASH评分分别为89.1和5.6，患者满意度中位数为10分中的9分。
无需翻修手术的患者术后结果评分优异：ASES平均评分为93.8，SANE平均评分为89.1，QuickDASH平均评分为5.6，患者满意度中位数为10分中的9分。关于ACCR技术应进一步研究以降低并发症风险并维持AC关节复位。
Ⅳ级，治疗性病例系列。
