Garofalo Raffaele, Ceccarelli Enrico, Castagna Alessandro, Calvisi Vittorio, Flanagin Brody, Conti Marco, Krishnan Sumant G
Shoulder Service F MIULLI Hospital, Km 4 strada per Santeramo, Acquaviva delle fonti, Bari, 70026, Italy.
Villa Stuart Sport Clinic, Rome, Italy.
Knee Surg Sports Traumatol Arthrosc. 2017 Jul;25(7):1989-1994. doi: 10.1007/s00167-017-4509-7. Epub 2017 Apr 22.
Appropriate surgical management for type V complete acromioclavicular (AC) joint dislocation remains controversial. The purpose of this paper is to retrospectively report the clinical and radiographic outcomes of an open surgical technique consisting for AC joint ligamentous and capsular reconstruction using autologous hamstring tendon grafts and semi-permanent sutures.
Between January 2005 and December 2011, 32 consecutive patients with symptomatic type V complete AC joint dislocation underwent surgical treatment using the same technique. The median time from injury to surgery was 45 days (range 24-90). The average median postoperative clinical and radiographic follow-up time was 30 months (range 24-33). Clinical outcomes measures included the ASES score, the visual analog score (VAS), and subjective patient satisfaction score. Minimum follow-up was 2 years.
ASES score increased from a median of 38.2 ± 6.2 preoperative to 92.1 ± 4.7 postoperatively (p ≤ 0.05). The median VAS score improved from 62 mm (range 45-100 mm) preoperatively to 8 mm (range 0-20 mm) at final follow-up (p ≤ 0.05). No patient experienced pain or discomfort with either direct palpation of the AC joint or with cross-body adduction. Final radiographs demonstrated symmetric AC joint contour in 25/32 (78%) patients. Seven patients (22%) radiographically demonstrated superior translation of the distal clavicle relative to the superior margin of the acromion but less than 50% of the clavicular width. 30/32 patients (93%) were able to return to their pre-injury level of work and sports activities.
This novel surgical technique using a free graft and braided suture for simultaneous coracoclavicular ligament and AC joint capsular reconstruction successfully controls superior and posterior translations after type V AC joint dislocation and minimizes the incidence of persistent postoperative AC joint subluxation.
Retrospective case series, Level IV.
对于Ⅴ型完全性肩锁关节脱位，合适的手术治疗方法仍存在争议。本文的目的是回顾性报告一种开放手术技术的临床和影像学结果，该技术包括使用自体腘绳肌腱移植物和半永久性缝线进行肩锁关节韧带和关节囊重建。
在2005年1月至2011年12月期间，32例有症状的Ⅴ型完全性肩锁关节脱位患者连续接受了使用相同技术的手术治疗。从受伤到手术的中位时间为45天（范围24 - 90天）。术后临床和影像学的平均中位随访时间为30个月（范围24 - 33个月）。临床结果指标包括美国肩肘外科医师学会（ASES）评分、视觉模拟评分（VAS）和患者主观满意度评分。最短随访时间为2年。
ASES评分从中位术前的38.2±6.2提高到术后的92.1±4.7（p≤0.05）。VAS评分中位值从术前的62毫米（范围45 - 100毫米）改善到最终随访时的8毫米（范围0 - 20毫米）（p≤0.05）。无论是直接触诊肩锁关节还是进行体侧内收时，均无患者感到疼痛或不适。最终X线片显示，25/32例（78%）患者的肩锁关节轮廓对称。7例（22%）患者的X线片显示锁骨远端相对于肩峰上缘向上移位，但小于锁骨宽度的50%。30/32例（93%）患者能够恢复到受伤前的工作和体育活动水平。
这种使用游离移植物和编织缝线同时重建喙锁韧带和肩锁关节囊的新型手术技术，成功地控制了Ⅴ型肩锁关节脱位后的向上和向后移位，并将术后持续性肩锁关节半脱位的发生率降至最低。
回顾性病例系列，Ⅳ级。
