Clavert P, Meyer A, Boyer P, Gastaud O, Barth J, Duparc F
Service de chirurgie du membre supérieur, CCOM, 10, avenue Baumann, 67400 Illkirch-Graffenstaden, France.
Chirurgie de l'épaule, groupe Maussins, 67, rue de Romainville, Paris, France.
Orthop Traumatol Surg Res. 2015 Dec;101(8 Suppl):S313-6. doi: 10.1016/j.otsr.2015.09.012. Epub 2015 Nov 3.
To report and analyze both the surgical and radiographic complications associated with anatomic coracoclavicular (CC) ligament procedures and to evaluate the effect of these complications on patient outcomes.
From July 2012 to July 2013, 116 primary anatomic CC ligament procedures (all arthroscopic endobutton fixations) were performed in 14 different centers. Demographic, surgical, subjective, and radiographic data were prospectively analyzed in 14 centers with a minimum follow-up of 12 months.
This series included 96 men and 20 women, mean age 37 years old, with a mean delay to surgery of 10 days. No intraoperative complications were reported. There were 11 complications due to hardware failure resulting in a loss of reduction, 1 coracoid fracture, 7 cases of adhesive capsulitis, 2 local infections, 5 cases of hardware pain. There were significant differences in outcomes between patients who did and did not develop complications: mean CS=71 vs. 93, (P<0.0001). All the parameters of the CS were statistically affected (P<0.0001). Forty-eight patients had persistent dislocation>150% on an AP X-ray which affected the pain and activity CS (P=0.023 and P=0.044). No preoperative predictive factors were identified. These patients could not return to the same level of sports activities due to persistent pain.
Anatomic procedures to treat AC joint dislocation using CC ligament reconstruction resulted in an overall complication rate of 22.4% and influenced the return to sports. Good to excellent outcomes were reported in patients without complications.
Level of evidence 4.
报告并分析与解剖学喙锁（CC）韧带手术相关的手术及影像学并发症，并评估这些并发症对患者预后的影响。
2012年7月至2013年7月期间，在14个不同中心进行了116例原发性解剖学CC韧带手术（均为关节镜下纽扣钢板固定）。对14个中心的人口统计学、手术、主观及影像学数据进行前瞻性分析，随访时间至少为12个月。
该系列包括96名男性和20名女性，平均年龄37岁，平均手术延迟时间为10天。未报告术中并发症。因内固定失败导致复位丢失的并发症有11例，喙突骨折1例，粘连性囊炎7例，局部感染2例，内固定疼痛5例。发生并发症和未发生并发症的患者预后存在显著差异：平均Constant评分（CS）分别为71分和93分（P<0.0001）。CS的所有参数均受到统计学影响（P<0.0001）。48例患者在前后位X线片上持续性脱位>150%，这影响了疼痛和活动CS评分（P=0.023和P=0.044）。未发现术前预测因素。由于持续疼痛，这些患者无法恢复到之前的运动水平。
采用CC韧带重建治疗肩锁关节脱位的解剖学手术总体并发症发生率为22.4%，并影响运动恢复。无并发症患者的预后报告为良好至优秀。
证据等级4。
