Cetinkaya Engin, Arıkan Yavuz, Beng Kubilay, Mutlu Harun, Yalçınkaya Merter, Üzümcügil Onat
Baltalimani Bone and Joint Diseases Training and Research Hospital, İstanbul, Turkey; Kolan Hospital, İstanbul, Turkey.
GOP Taksim Training and Research Hospital Department of Orthopaedics and Traumatology, İstanbul, Turkey.
Acta Orthop Traumatol Turc. 2017 Dec;51(6):455-458. doi: 10.1016/j.aott.2017.09.002. Epub 2017 Oct 9.
The aim of this study was to compare the long-term clinical and radiological results of Acromioclavicular (AC) fixation with K-wires (the modified Phemister procedure) and Coracoclavicular (CC) fixation with the Bosworth screw in the surgical treatment of Type 3 AC joint dislocations.
Thirty-two patients with complete set of medical records and who received surgical treatment between September 2005 and January 2009 due to acute Rockwood Type 3 AC joint dislocation and properly attended their follow-ups were retrospectively evaluated. Sixteen patients (13 males, 3 females; mean age: 38, range: 24-52 years) were treated with CC fixation with Bosworth screw (Group 1), and the other 16 (12 males, 4 females; mean age: 53.3, range: 38-64 years) with AC fixation using K-wires (Group 2).
The mean follow-up time was 96 months for Group 1 and 93 months for Group 2 patients (p > 0.05). The mean Constant-Murley score at the final follow-up was 84.7 in Group 1 and 87.3 in Group 2 (p = 0.069). Radiological evaluation of the patients revealed AC arthrosis in 2 and 3 patients in Group 1 and 2, respectively. In Group 2, one patient had a recurrent dislocation, three patients had AC arthrosis and two patients had ossification in the CC ligament (Fig. 2). There was no superficial or deep wound infection in Group 1, while two patients from Group 2 had a superficial wound infection.
Our results suggest that both techniques are reliable and provide adequate reduction and similar outcomes in terms of functionality and pain levels, following the reduction of Type 3 AC joint dislocations. With lower rates of wound site infection in the early and AC arthrosis in the late postoperative period, CC fixation method with the Bosworth screw may be a better surgical option than AC fixation method with K-wires.
Level III, Therapeutic study.
本研究旨在比较克氏针（改良菲米斯特手术）肩锁关节（AC）固定与博斯沃思螺钉喙锁关节（CC）固定在手术治疗3型AC关节脱位中的长期临床和影像学结果。
回顾性评估32例有完整病历且因急性罗克伍德3型AC关节脱位于2005年9月至2009年1月接受手术治疗并按时随访的患者。16例患者（13例男性，3例女性；平均年龄：38岁，范围：24 - 52岁）采用博斯沃思螺钉CC固定（第1组），另外16例（12例男性，4例女性；平均年龄：53.3岁，范围：38 - 64岁）采用克氏针AC固定（第2组）。
第1组患者的平均随访时间为96个月，第2组为93个月（p > 0.05）。末次随访时第1组的平均Constant - Murley评分为84.7，第2组为87.3（p = 0.069）。患者的影像学评估显示，第1组和第2组分别有2例和3例出现AC关节病。在第2组中，1例患者复发性脱位，3例患者出现AC关节病，2例患者CC韧带骨化（图2）。第1组无浅表或深部伤口感染，而第2组有2例患者出现浅表伤口感染。
我们的结果表明，两种技术都可靠，在3型AC关节脱位复位后，在功能和疼痛水平方面都能提供充分复位和相似的结果。博斯沃思螺钉CC固定方法在术后早期伤口感染率较低，后期AC关节病发生率较低，可能是比克氏针AC固定方法更好的手术选择。
III级，治疗性研究。
