Athar M S, Ashwood Neil, Arealis Georgios, Hamlet Mark, Salt Emma
1 Queen's Hospital - Burton Hospitals NHS Foundation Trust Burton upon Trent, UK.
2 East Kent Hospitals University NHS Foundation Trust, Kent, UK.
J Orthop Surg (Hong Kong). 2018 Jan-Apr;26(1):2309499017749984. doi: 10.1177/2309499017749984.
Acromioclavicular joint injuries are common shoulder girdle injuries most commonly resulting from a direct blow to the acromion with the arm adducted. Type-I or type-II acromioclavicular joint injuries can be managed with sling immobilization, early shoulder motion, and physiotherapy. The management of type-III injuries remains controversial and is individualized. Type IV and V injuries should be treated surgically. A myriad of surgical techniques for the management of acromioclavicular joint injuries have been reported.
We present a comparative study of 76 patients treated with two most common modalities of treatment for AC joint disruption and that is Hook plate stabilisation (n=52) or arthroscopically assisted tight rope stabilisation (n=24). The primary objective was to establish whether hook plate stabilization was superior compared to arthroscopic tight rope fixation in reducing pain and increasing function in the short-term and long-term for patients with AC joint disruptions III-IV. We also wanted to assess how quickly patients returned to their work/job. It was a prospective study, we included all the patients operated between 2008 and 2015 for AC joint disruption by the two shoulder surgeons of our department. All patients followed a strict physiotherapy protocol and were assessed at 6 weeks, 3 months and 12 months. We used the Harm and cost criteria of assessment and the patient specific functional outcome scores.
Both modalities of treatment have high patient satisfaction rate, return to work is faster in tight rope group but after a year both group of patients returned to their premorbid state. Removal of hook plate is not mandatory and lysis of acromion is rare (1% in our series).
Despite the fact that both methods yielded similar results and have statistically similar number of complications, the type of postoperative complications was different between groups. The plate group had more postoperative pain and worse function but both aspects improved after plate removal. The rope group had more complex complications including deep infection and recurrence of deformity and fracture. These differences should be taken into consideration when consenting the patient regarding possible treatment.
肩锁关节损伤是常见的肩胛带损伤，最常见的原因是手臂内收时肩部受到直接撞击。I型或II型肩锁关节损伤可通过吊带固定、早期肩部活动及物理治疗来处理。III型损伤的治疗仍存在争议，需个体化处理。IV型和V型损伤应手术治疗。已有多种手术技术用于治疗肩锁关节损伤的报道。
我们对76例接受肩锁关节脱位两种最常见治疗方式的患者进行了一项对比研究，即钩钢板固定（n = 52）或关节镜辅助下张力带固定（n = 24）。主要目的是确定对于III - IV型肩锁关节脱位患者，在短期和长期内，钩钢板固定在减轻疼痛和改善功能方面是否优于关节镜下张力带固定。我们还想评估患者恢复工作的速度。这是一项前瞻性研究，纳入了2008年至2015年间由我们科室两位肩部外科医生进行肩锁关节脱位手术的所有患者。所有患者均遵循严格的物理治疗方案，并在6周、3个月和12个月时进行评估。我们使用了Harm和成本评估标准以及患者特定功能结局评分。
两种治疗方式的患者满意度都很高，张力带组恢复工作更快，但一年后两组患者均恢复到病前状态。钩钢板并非必须取出，肩峰溶解罕见（我们的系列中为1%）。
尽管两种方法产生了相似的结果，且并发症数量在统计学上相似，但两组术后并发症的类型不同。钢板组术后疼痛更多，功能更差，但取出钢板后这两方面均有所改善。张力带组有更复杂的并发症，包括深部感染和畸形及骨折复发。在向患者告知可能的治疗方案时，应考虑到这些差异。
