Barth J, Duparc F, Baverel L, Bahurel J, Toussaint B, Bertiaux S, Clavert P, Gastaud O, Brassart N, Beaudouin E, De Mourgues P, Berne D, Duport M, Najihi N, Boyer P, Faivre B, Meyer A, Nourissat G, Poulain S, Bruchou F, Ménard J F
Centre ostéo-articulaire des Cèdres, parc Sud Galaxie, 5, rue des Tropiques, 38130 Échirolles, France.
CHU de Rouen, 76000 Rouen, France.
Orthop Traumatol Surg Res. 2015 Dec;101(8 Suppl):S305-11. doi: 10.1016/j.otsr.2015.09.002. Epub 2015 Oct 23.
Treatment of chronic acromioclavicular joint dislocation (ACJD) remains a poorly known and controversial subject. Given the many surgical options, it is not always easy to determine which steps are indispensable.
This article reports a multicenter prospective study. The clinical and radiological follow-up involved a comparative analysis of the preoperative and postoperative data at 1 year, including pain (visual analogue scale), subjective functional incapacity (QuickDASH), and the objective Constant score, as well as a comparative analysis of vertical and horizontal movements measured on simple x-rays.
Based on a series of 140 operated ACJDs, we included 24 chronic ACJDs. The mean time to surgery was 46 weeks (range, 1 month to 4 years). The patients' mean age was 41 years, with a majority of males (75%), 72% of whom participated in recreational sports. Professionally, 40% of the subjects had jobs involving manual labor. We noted 40% grade III, 24% grade IV, and 36% grade V injury according to the Rockwood classification. In 92% of cases, coracoclavicular stabilization was provided by a double button implant, reinforced with a biological graft in 88% of the cases. In 29%, millimeters to centimeters of the distal clavicle were resected and acromioclavicular stabilization was associated in 54%. We observed complications in 33% of the cases. At 1 year postoperative, 21 patients underwent clinical and radiological follow-up (87.5%). Only 35% of the patients were satisfied or very satisfied, whereas 100% of them would recommend the operation. Full-time work was resumed in 91% of the cases and all sports could be resumed in 86%. The pre- and postoperative values at 1 year changed as follows: the mean Constant score improved from 61 to 87 (p=0.00002); the subjective QuickDASH score decreased from 41 to 9 (p=0.00002); and radiologically significant reduction of the initial displacement was observed in the vertical plane (p<10(-3)) and the horizontal plane (p=0.022).
In this study, the favorable prognostic factors found were: time to surgery less than 3 months (p=0.02), associated acromioclavicular stabilization, and postoperative immobilization with a sling extended to 6 weeks. However, resection of the distal clavicle did not influence the final result.
Level II prospective non-randomized comparative study.
慢性肩锁关节脱位（ACJD）的治疗仍是一个鲜为人知且存在争议的课题。鉴于有多种手术选择，确定哪些步骤必不可少并非总是易事。
本文报告了一项多中心前瞻性研究。临床和影像学随访包括对1年时术前和术后数据的对比分析，其中有疼痛（视觉模拟评分）、主观功能障碍（QuickDASH）、客观的Constant评分，以及对简单X线片上测量的垂直和水平运动的对比分析。
基于140例接受手术的ACJD病例系列，我们纳入了24例慢性ACJD。手术的平均时间为46周（范围为1个月至4年）。患者的平均年龄为41岁，男性占大多数（75%），其中72%参与休闲运动。职业方面，40%的受试者从事体力劳动工作。根据Rockwood分类，我们注意到40%为III级损伤，24%为IV级损伤，36%为V级损伤。在92%的病例中，采用双纽扣植入物进行喙锁固定，88%的病例中用生物移植物进行加强。29%的病例中切除了锁骨远端几毫米至几厘米，并在54%的病例中联合进行肩锁固定。我们在33%的病例中观察到并发症。术后1年，21例患者接受了临床和影像学随访（87.5%）。只有35%的患者满意或非常满意，而100%的患者会推荐该手术。91%的病例恢复了全职工作，86%的病例可以恢复所有运动。1年时术前和术后的值变化如下：平均Constant评分从61提高到87（p = 0.00002）；主观QuickDASH评分从41降至9（p = 0.00002）；并且在垂直平面（p < 10⁻³）和水平平面（p = 0.022）观察到初始移位在影像学上有显著减少。
在本研究中，发现的有利预后因素为：手术时间少于3个月（p = 0.02）、联合肩锁固定以及用吊带进行术后固定6周。然而，锁骨远端切除术并未影响最终结果。
II级前瞻性非随机对照研究。
