Rasmont Quentin, Delloye Christian, Bigare Elisa, Van Isacker Tom
Acta Orthop Belg. 2015 Mar;81(1):107-14.
The optimal treatment of grade III acromioclavicular (AC) dislocation is still controversial. Recent studies recommend surgery at that stage whereas meta-analysis favours conservative management. The objective of the present investigation was to analyse a clinical series of non-operated grade III AC dislocations and to determine their functional status. Thirty-five patients treated conservatively with a grade III acromioclavicular dislocation were retrospectively reviewed. Simple shoulder test, Oxford shoulder and bilateral Constant shoulder score were used for assessment. Various predictive criteria of poor outcome, particularly scapular dyskinesis were taken into account for analysis. Overall mean and median Constant Score of the injured side were 92.9 and 94, whilst the contralateral shoulder values were respectively 94.9 and 95 (mean and median scores). Ten patients had scapular dyskinesis. Laterality, shoulder activity and scapular dyskinesis were not statistically related to worse outcome. Twenty-eight (80%) patients resumed normal activity within six months. All but two patients were subjectively very satisfied or satisfied. Conservative treatment provided satisfactory results whatever the shoulder activity. No risk factors were predictive of a poorer outcome. Conservative management should remain the first option to manage these injuries.
III 度肩锁关节（AC）脱位的最佳治疗方法仍存在争议。近期研究建议在该阶段进行手术，而荟萃分析则倾向于保守治疗。本研究的目的是分析一组非手术治疗的 III 度 AC 脱位患者的临床情况，并确定其功能状态。对 35 例接受保守治疗的 III 度肩锁关节脱位患者进行了回顾性研究。采用简单肩部测试、牛津肩部评分和双侧 Constant 肩部评分进行评估。分析时考虑了各种预后不良的预测标准，尤其是肩胛运动障碍。患侧 Constant 评分的总体均值和中位数分别为 92.9 和 94，而对侧肩部的值分别为 94.9 和 95（均值和中位数评分）。10 例患者存在肩胛运动障碍。左右侧别、肩部活动度和肩胛运动障碍与较差的预后在统计学上无相关性。28 例（80%）患者在 6 个月内恢复了正常活动。除 2 例患者外，所有患者主观上都非常满意或满意。无论肩部活动情况如何，保守治疗均取得了满意的效果。没有危险因素可预测预后较差。保守治疗应仍然是处理这些损伤的首选方法。
