Hashiguchi Hiroshi, Iwashita Satoshi, Abe Kazumasa, Sonoki Kentaro, Yoneda Minoru, Takai Shinro
Department of Orthopaedic Surgery, Nippon Medical School Chiba Hokusoh Hospital.
Department of Orthopaedic Surgery, Nippon Medical School.
J Nippon Med Sch. 2018;85(3):166-171. doi: 10.1272/jnms.JNMS.2018_85-24.
The purpose of this study was to evaluate mid- and long-term clinical and radiologic outcomes of arthroscopic coracoclavicular ligament reconstruction (ACCLR) with an artificial ligament for acute dislocation of the acromioclavicular joint (ACJ).
Twelve male patients (average age at the time of surgery: 40.8 years, range: 21-64 years) underwent ACCLR with an artificial ligament for acute dislocation of the ACJ type III or type V according to the Rockwood classification. Arthroscopic surgery was performed with the patient under general anesthesia and interscalene brachial plexus block in the beach-chair position. Reduction of the ACJ was performed manually or using an elevator under control of an imaging intensifier. The ACJ was fixed temporarily with a Kirschner wire. Bone tunnels of the coracoid process and clavicle were made with a cannulated drill. An artificial ligament was pulled out through the bone tunnels and fixed on the upper surface of the clavicle with a staple and interference screw, and on the undersurface of the coracoid process with an Endobutton. The shoulder was immobilized with a shoulder brace for 4 weeks postoperatively, and rehabilitation was started in the first postoperative week. The Japan Shoulder Society Acromioclavicular Joint Function Assessment (JSS-ACJ) score was used for evaluation of clinical outcomes, and plain radiographs were performed after a minimum follow-up period of 5 years postoperatively.
The average follow-up period after surgery was 106.3 months (range: 62-128 months). The average postoperative JSS-ACJ score was 97.2 points (range: 92-100). The seven patients who had been playing sports before injury all returned to their pre-injury level. No patients complained of pain or shoulder dysfunction in daily activities, work, or sports. There were no complications such as neurovascular injuries during surgery, infection, or foreign body reaction from the artificial ligament. Radiographs at the final follow-up showed subluxation of the ACJ and non-symptomatic osteoarthritic changes of the ACJ in two patients, respectively.
ACCLR for acute dislocation of the ACJ is a useful surgical procedure that gives satisfactory clinical and radiologic outcomes on mid- and long-term follow-up. ACCLR can stabilize vertical instability of the ACJ. If instability in the horizontal direction remains, repair or reconstruction of the acromioclavicular ligament should be added to prevent osteoarthritic changes of the ACJ.
本研究的目的是评估采用人工韧带进行关节镜下喙锁韧带重建术（ACCLR）治疗肩锁关节（ACJ）急性脱位的中长期临床和影像学结果。
12例男性患者（手术时平均年龄：40.8岁，范围：21 - 64岁）根据Rockwood分类法，因III型或V型ACJ急性脱位接受了人工韧带ACCLR。在全身麻醉和肌间沟臂丛神经阻滞下，患者取沙滩椅位进行关节镜手术。通过手动或在影像增强器控制下使用骨膜剥离器对ACJ进行复位。用克氏针临时固定ACJ。用空心钻在喙突和锁骨上制作骨隧道。将人工韧带穿过骨隧道，用U型钉和挤压螺钉固定在锁骨上表面，用Endobutton固定在喙突下表面。术后用肩部支具固定肩部4周，并在术后第一周开始康复治疗。采用日本肩肘学会肩锁关节功能评估（JSS - ACJ）评分评估临床结果，术后至少随访5年时拍摄X线平片。
术后平均随访时间为106.3个月（范围：62 - 128个月）。术后JSS - ACJ评分平均为97.2分（范围：92 - 100）。7例受伤前从事体育运动的患者均恢复到受伤前水平。没有患者在日常活动、工作或运动中抱怨疼痛或肩部功能障碍。手术过程中没有发生神经血管损伤、感染或人工韧带异物反应等并发症。末次随访时的X线片显示，分别有2例患者存在ACJ半脱位和ACJ无症状性骨关节炎改变。
ACCLR治疗ACJ急性脱位是一种有效的手术方法，中长期随访时临床和影像学结果令人满意。ACCLR可稳定ACJ的垂直不稳定。如果水平方向仍存在不稳定，应增加肩锁韧带的修复或重建以预防ACJ的骨关节炎改变。
