Cisneros Luis Natera, Reiriz Juan Sarasquete
Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, 08026, Barcelona, Spain.
Hospital General de Catalunya, Pedro i Pons 1, 08190, Sant Cugat del Vallés, Barcelona, Spain.
Eur J Orthop Surg Traumatol. 2017 Apr;27(3):323-333. doi: 10.1007/s00590-016-1898-0. Epub 2017 Jan 5.
To determine the prevalence of remaining horizontal instability in high-grade acromioclavicular joint (ACJ) injuries surgically managed by means of four different surgical strategies and to assess its relation to the clinical outcomes and the quality of life.
In this multicentric non-randomized retrospective study, 53 patients with high-grade ACJ injuries surgically managed (by means of open or arthroscopic surgery) were clinically and radiographically assessed at 24 months or more after shoulder surgery. The presence of post-surgical remaining horizontal instability was evaluated by means of Alexander or axillary X-ray views. The study population was divided into two groups: patients with evidence of post-surgical remaining horizontal instability and patients without evidence of post-surgical remaining horizontal instability at the last follow-up visit. The relationship between remaining horizontal instability and the quality-of-life questionnaires was analyzed.
18.87% (10/53) of the Alexander or axillary X-rays views showed post-surgical remaining horizontal instability at the last follow-up visit (INSTAB-group). Results of the questionnaires were: (1) physical SF36 score (INSTAB-group 57.02 ± 3.17 and NO-INSTAB-group 57.66 ± 3.30, p = 0.583); (2) mental SF36 score (INSTAB-group 53.95 ± 3.98 and NO-INSTAB-group 55.71 ± 3.30, p = 0.150); (3) NRS for pain (INSTAB-group 1.30 ± 1.49 and NO-INSTAB-group 0.83 ± 1.08, p = 0.260); (4) DASH questionnaire (INSTAB-group 5.27 ± 5.42 and NO-INSTAB-group 3.06 ± 2.30, p = 0.049); (5) Constant score (INSTAB-group 93.4 ± 3.5 and NO-INSTAB-group 94.83 ± 4.3, p = 0.333); and Global satisfaction (INSTAB-group 8.7 ± 0.95 and NO-INSTAB-group 8.64 ± 1.03, p = 0.874).
Independently of the type of procedure, post-surgical remaining horizontal instability was present in almost one-fifth of the patients, and this group of patients showed a significantly worse DASH score. The addition of an acromioclavicular augmentation might have to be considered, taking into account that its absence may have a negative impact in terms of shoulder disabilities.
Level IV, prognostic case series.
确定采用四种不同手术策略进行手术治疗的高级别肩锁关节（ACJ）损伤中残留水平不稳定的发生率，并评估其与临床结果和生活质量的关系。
在这项多中心非随机回顾性研究中，对53例接受手术治疗（通过开放手术或关节镜手术）的高级别ACJ损伤患者在肩部手术后24个月或更长时间进行了临床和影像学评估。通过亚历山大位或腋位X线片评估术后残留水平不稳定的情况。研究人群分为两组：在最后一次随访时存在术后残留水平不稳定证据的患者和不存在术后残留水平不稳定证据的患者。分析残留水平不稳定与生活质量问卷之间的关系。
在最后一次随访时，18.87%（10/53）的亚历山大位或腋位X线片显示存在术后残留水平不稳定（不稳定组）。问卷结果如下：（1）SF36身体评分（不稳定组57.02±3.17，无不稳定组57.66±3.30，p = 0.583）；（2）SF36心理评分（不稳定组53.95±3.98，无不稳定组55.71±3.30，p = 0.150）；（3）疼痛数字评分法（NRS）（不稳定组1.30±1.49，无不稳定组0.83±1.08，p = 0.260）；（4）上肢功能障碍评分（DASH）问卷（不稳定组5.27±5.42，无不稳定组3.06±2.30，p = 0.049）；（5）Constant评分（不稳定组93.4±3.5，无不稳定组94.83±4.3，p = 0.333）；以及总体满意度（不稳定组8.7±0.95，无不稳定组8.64±1.03，p = 0.874）。
无论手术方式如何，近五分之一的患者存在术后残留水平不稳定，且该组患者的DASH评分明显更差。考虑到肩锁关节增强术的缺失可能对肩部功能障碍产生负面影响，可以考虑增加该手术。
IV级，预后病例系列。
