Loriaut P, Casabianca L, Alkhaili J, Dallaudière B, Desportes E, Rousseau R, Massin P, Boyer P
Service de chirurgie orthopédique et de traumatologie, hôpital de la Pitié-Salpêtrière, université Pierre-et-Marie-Curie, 47, boulevard de l'Hôpital, 75013 Paris, France; Institut de chirurgie orthopédique, clinique des Lilas, 41-49, avenue du Maréchal-Juin, 93260 Les Lilas, France.
Service de chirurgie orthopédique et de traumatologie, hôpital de la Pitié-Salpêtrière, université Pierre-et-Marie-Curie, 47, boulevard de l'Hôpital, 75013 Paris, France.
Orthop Traumatol Surg Res. 2015 Dec;101(8):895-901. doi: 10.1016/j.otsr.2015.09.024. Epub 2015 Nov 3.
Arthroscopic treatment of acute grade 3 and 4 acromioclavicular dislocation is controversial, due to the risk of recurrence and of postoperative reduction defect. The purpose of the present study was to investigate whether the healing of the acromioclavicular (AC) and coracoclavicular (CC) ligaments and the accurate 3D positioning parameters of the AC joint using MRI were correlated with satisfactory functional outcome.
Thirty-nine patients were enrolled from 2009 to 2011 and managed arthroscopically by CC lacing using a double-button device.
Clinical assessment included the Shoulder and Hand (QuickDash) score, Constant-Murley score and visual analog scale (VAS) for residual pain. Time and rate to return to work and return to sport were assessed according to type of sport and work. Postoperative complications were recorded. Radiological examination consisted of anteroposterior clavicle and lateral axillary radiographs. AC ligament healing and 3D joint congruency were assessed on MRI and correlated to the clinical results.
Mean patient age was 35.7 years (range, 20-55). Mean follow-up was 42.3±10.6 months (range, 24-60). At final follow-up, mean QuickDash score, Constant score and VAS were respectively 1.7±4 (range, 0-11), 94.7±7.3 (range, 82-100) and 0.5±1.4 (range, 0-2). Thirty-five (90%) patients were able to resume work, including heavy manual labor, and sport. Radiology found accurate 3D joint congruency in 34 patients (87%) and CC and AC ligament healing in 36 (93%). Complications included reduction loss at 6 weeks in 3 patients, requiring surgical stabilization. Satisfactory functional results were associated with accurate AC joint congruency in the coronal and axial planes (P<0.05) and good AC and CC ligament healing (P<0.04). An initial 25% reduction defect in the coronal plane was not associated with poor functional results (P=0.07).
Arthroscopic treatment by CC lacing satisfactorily restored ligament and joint anatomy in the present series. These satisfactory anatomic results correlated with good clinical outcome encourage continuing with this technique.
Level IV, therapeutic case series.
由于存在复发风险和术后复位缺陷风险，急性3级和4级肩锁关节脱位的关节镜治疗存在争议。本研究的目的是调查肩锁（AC）韧带和喙锁（CC）韧带的愈合情况以及使用MRI测量的AC关节精确三维定位参数是否与满意的功能结果相关。
2009年至2011年共纳入39例患者，采用双纽扣装置通过CC韧带缝合术进行关节镜治疗。
临床评估包括肩手（QuickDash）评分、Constant-Murley评分以及残余疼痛的视觉模拟量表（VAS）。根据运动和工作类型评估恢复工作和恢复运动的时间及比例。记录术后并发症。放射学检查包括锁骨前后位和腋窝侧位X线片。在MRI上评估AC韧带愈合情况和关节三维一致性，并与临床结果相关联。
患者平均年龄为35.7岁（范围20 - 55岁）。平均随访时间为42.3±10.6个月（范围24 - 60个月）。末次随访时，QuickDash评分、Constant评分和VAS评分分别为1.7±4（范围0 - 11）、94.7±7.3（范围82 - 100）和0.5±1.4（范围0 - 2）。35例（90%）患者能够恢复工作，包括重体力劳动和运动。放射学检查发现34例（87%）患者关节三维一致性准确，36例（93%）患者CC和AC韧带愈合。并发症包括3例患者在6周时出现复位丢失，需要手术稳定。满意的功能结果与冠状面和轴位面上AC关节的准确一致性（P<0.05）以及AC和CC韧带的良好愈合（P<0.04）相关。冠状面初始25%的复位缺陷与功能结果不佳无关（P = 0.07）。
在本系列研究中，通过CC韧带缝合术进行关节镜治疗可令人满意地恢复韧带和关节解剖结构。这些令人满意的解剖学结果与良好的临床结果相关，鼓励继续采用该技术。
IV级，治疗性病例系列。
