Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Medical College of Hallym University, Hwaseong, Republic of Korea.
Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Medical College of Hallym University, Hwaseong, Republic of Korea.
Arthroscopy. 2019 Jan;35(1):14-21. doi: 10.1016/j.arthro.2018.07.007. Epub 2018 Nov 16.
To introduce an arthroscopically assisted coracoclavicular (CC) fixation technique using multiple low-profile devices to evaluate the clinical and radiologic outcomes in patients with acute high-grade acromioclavicular (AC) joint dislocation.
Between July 2014 and September 2015, cases of AC joint dislocation that were treated with arthroscopic CC fixation using multiple low-profile devices with a minimum follow-up of 24 months were included. We measured the vertical coracoclavicular distance (CCD) on the anteroposterior view and the horizontal acromioclavicular distance on 3-dimensional computed tomography images to evaluate the changes in radiologic outcomes before and after surgery. We compared final radiologic outcomes between initial AC reduction groups based on hierarchical clustering. Clinical outcomes were evaluated using the Constant-Murley score.
We enrolled 27 patients in total, and the mean follow-up period was 27.2 months. The mean CCD of the injured shoulder was 13.68 ± 3.98 mm preoperatively and decreased to 5.72 ± 1.68 mm immediately postoperatively but increased to 7.32 ± 2.29 mm at last follow-up (P = .07). Horizontal displacement of the distal clavicle was 1.1 ± 1.0 mm immediately postoperatively but decreased to 0.9 ± 0.6 mm at last follow-up (P < .05). In particular, in the 2 groups that were determined using the hierarchical cluster analysis, patients with excellent recovery of the initial CCD (20 patients) showed less of an increase in the CCD at last follow-up than did those in the other group (7 patients) (P < .001). The Constant-Murley score was 93.5 ± 2.7 points on the injured side at last follow-up (P = .074).
Our CC fixation technique with multiple low-profile devices exhibited satisfactory clinical and radiologic outcomes. In particular, ensuring good initial recovery of the CCD and the precise placement and location of the AC joints was important in maintaining the proper AC position at the final follow-up.
Level IV, case series.
介绍一种使用多个微创装置辅助关节镜下喙锁（CC）固定的技术，评估急性重度肩锁关节（AC）脱位患者的临床和影像学结果。
2014 年 7 月至 2015 年 9 月，我们纳入了使用多个微创装置进行关节镜下 CC 固定治疗的 AC 关节脱位患者，这些患者的随访时间至少为 24 个月。我们测量了前后位 X 线片上的垂直 CC 距离（CCD）和三维 CT 图像上的水平 AC 距离，以评估手术前后影像学结果的变化。我们根据层次聚类比较了初始 AC 复位组的最终影像学结果。使用 Constant-Murley 评分评估临床结果。
我们共纳入 27 例患者，平均随访时间为 27.2 个月。受伤侧的平均 CCD 术前为 13.68 ± 3.98mm，术后即刻降至 5.72 ± 1.68mm，但在末次随访时增至 7.32 ± 2.29mm（P =.07）。锁骨远端的水平移位术后即刻为 1.1 ± 1.0mm，但在末次随访时降至 0.9 ± 0.6mm（P <.05）。特别是在通过层次聚类分析确定的 2 组中，初始 CCD 恢复良好的患者（20 例）在末次随访时的 CCD 增加量明显低于另一组患者（7 例）（P <.001）。末次随访时患侧的 Constant-Murley 评分为 93.5 ± 2.7 分（P =.074）。
我们使用多个微创装置的 CC 固定技术显示出了满意的临床和影像学结果。特别是确保 CCD 有良好的初始恢复以及 AC 关节的准确放置和位置，对于在最终随访时保持适当的 AC 位置非常重要。
IV 级，病例系列。
