Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland.
Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland. ; BCRU, Institute of Clinical Medicine, University of Eastern Finland, Finland.
Orthop J Sports Med. 2014 Dec 11;2(12):2325967114560130. doi: 10.1177/2325967114560130. eCollection 2014 Dec.
The optimal treatment of acute, complete dislocation of the acromioclavicular joint (ACJ) is still unresolved.
To determine the difference between operative and nonoperative treatment in acute Rockwood types III and V ACJ dislocation.
Randomized controlled trial; Level of evidence, 2.
In the operative treatment group, the ACJ was reduced and fixed with 2 transarticular Kirschner wires and ACJ ligament suturing. The Kirschner wires were extracted after 6 weeks. Nonoperatively treated patients received a reduction splint for 4 weeks. At the 18- to 20-year follow-up, the Constant, University of California at Los Angeles Shoulder Rating Scale (UCLA), Larsen, and Simple Shoulder Test (SST) scores were obtained, and clinical and radiographic examinations of both shoulders were performed.
Twenty-five of 35 potential patients were examined at the 18- to 20-year follow-up. There were 11 patients with Rockwood type III and 14 with type V dislocations. Delayed surgical treatment for ACJ was used in 2 patients during follow-up: 1 in the operatively treated group and 1 in the nonoperatively treated group. Clinically, ACJs were statistically significantly less prominent or unstable in the operative group than in the nonoperative group (normal/prominent/unstable: 9/4/3 and 0/6/3, respectively; P = .02) and in the operative type III (P = .03) but not type V dislocation groups. In operatively and nonoperatively treated patients, the mean Constant scores were 83 and 85, UCLA scores 25 and 27, Larsen scores 11 and 11, and SST scores 11 and 12 at follow-up, respectively. There were no statistically significant differences in type III and type V dislocations. In the radiographic analysis, the ACJ was wider in the nonoperative than the operative group (8.3 vs 3.4 mm; P = .004), and in the type V dislocations (nonoperative vs operative: 8.5 vs 2.4 mm; P = .007). There was no statistically significant difference between study groups in the elevation of the lateral end of the clavicle. Both groups showed equal levels of radiologic signs of ACJ osteoarthritis and calcification of the coracoclavicular ligaments.
Nonoperative treatment was shown to produce more prominent or unstable and radiographically wider ACJs than was operative treatment, but clinical results were equally good in the study groups at 18- to 20-year follow-up. Both treatment methods showed statistically significant radiographic elevations of the lateral clavicle when compared with a noninjured ACJ.
急性完全性肩锁关节（ACJ）脱位的最佳治疗方法仍未确定。
确定手术与非手术治疗急性 Rockwood Ⅲ型和Ⅴ型 ACJ 脱位的差异。
随机对照试验；证据水平，2。
在手术治疗组中，通过 2 根关节内克氏针和 ACJ 韧带缝合将 ACJ 复位并固定。6 周后取出克氏针。非手术治疗的患者使用 4 周的复位夹板。在 18 至 20 年的随访中，获得了 Constant、加利福尼亚大学洛杉矶分校（UCLA）肩部评分量表（UCLA）、Larsen 和简单肩部测试（SST）评分，并对双侧肩部进行了临床和影像学检查。
35 名潜在患者中有 25 名在 18 至 20 年的随访中接受了检查。其中 11 例为 Rockwood Ⅲ型，14 例为Ⅴ型脱位。在随访过程中，2 例 ACJ 延迟手术治疗：1 例在手术治疗组，1 例在非手术治疗组。临床上，与非手术组相比，手术组的 ACJ 明显更突出或不稳定（正常/突出/不稳定：9/4/3 和 0/6/3；P =.02），手术Ⅲ型（P =.03）但不是Ⅴ型脱位组。在手术和非手术治疗的患者中，术后 18 至 20 年随访时的平均 Constant 评分分别为 83 和 85，UCLA 评分分别为 25 和 27，Larsen 评分分别为 11 和 11，SST 评分分别为 11 和 12。Ⅲ型和Ⅴ型脱位之间无统计学差异。在影像学分析中，非手术组的 ACJ 比手术组更宽（8.3 比 3.4 毫米；P =.004），Ⅴ型脱位（非手术比手术：8.5 比 2.4 毫米；P =.007）。研究组之间在锁骨外侧端的抬高方面没有统计学差异。两组均显示出相同程度的 ACJ 骨关节炎放射学征象和喙锁韧带钙化。
与手术治疗相比，非手术治疗会导致更突出或不稳定，影像学上 ACJ 更宽，但在 18 至 20 年的随访中，研究组的临床结果同样良好。与未受伤的 ACJ 相比，两种治疗方法均显示出锁骨外侧端的统计学上显著升高。
