Sanchez-Sotelo Joaquin, Baghdadi Yaser, Nguyen Ngoc Tram V
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
JSES Open Access. 2018 Dec 18;2(4):190-193. doi: 10.1016/j.jses.2018.08.002. eCollection 2018 Dec.
The sternoclavicular joint may become unstable as a result of trauma or medial clavicle resection for arthritis. Allograft reconstruction with the figure-of-8 configuration is commonly used. This study was conducted to determine the outcome of sternoclavicular joint reconstruction using an alternative graft configuration.
Between 2005 and 2013, 19 sternoclavicular joint reconstructions were performed using a semitendinous allograft in a sternal docking configuration. The median age at surgery was 44 years (range, 15-79 years). Indications included instability in 16 (anterior, 13; posterior, 3) or medial clavicle resection for osteoarthritis in 3. The median follow-up time was 3 years (range, 1-9 years).
Two reconstructions (10.5%) underwent revision surgery, 1 additional patient had occasional subjective instability, and the remaining 16 (84%) were considered stable. Sternoclavicular joint reconstruction led to improved pain (visual analog scale for pain subsided from 5 to 1 point, < .01), with pain being rated as mild or none for 15 shoulders. At the most recent follow-up, the median 11-item version of the Disabilities of the Arm, Shoulder and Hand and American Shoulder and Elbow Surgeons scores were 11 (interquartile range [IQR], 0-41) and 88 (IQR, 62-100) respectively. The cosmetic aspect of the shoulder was satisfactory in 16 reconstructions (84%), with a median of 10 points (IQR, 9-10 points) on the visual analog scale for overall satisfaction.
Reconstruction of the sternoclavicular joint with a semitendinous allograft in a sternal docking fashion restores stability in most patients requiring surgery for instability of the sternoclavicular joint or medial clavicle resection for osteoarthritis.
胸锁关节可能因创伤或因关节炎行内侧锁骨切除而变得不稳定。常用8字构型的同种异体移植重建。本研究旨在确定使用另一种移植构型进行胸锁关节重建的结果。
2005年至2013年期间，采用半腱肌同种异体移植以胸骨对接构型进行了19例胸锁关节重建。手术时的中位年龄为44岁（范围15 - 79岁）。适应证包括16例不稳定（前方13例，后方3例）或3例因骨关节炎行内侧锁骨切除。中位随访时间为3年（范围1 - 9年）。
2例重建（10.5%）接受了翻修手术，另有1例患者偶尔有主观不稳定感，其余16例（84%）被认为稳定。胸锁关节重建使疼痛改善（疼痛视觉模拟评分从5分降至1分，P <.01），15个肩关节的疼痛评分为轻度或无疼痛。在最近一次随访时，手臂、肩部和手部功能障碍11项版本评分及美国肩肘外科医师协会评分的中位数分别为11分（四分位间距[IQR]，0 - 41）和88分（IQR，62 - 100）。16例重建（84%）肩部的外观令人满意，总体满意度视觉模拟评分的中位数为10分（IQR，9 - 10分）。
采用半腱肌同种异体移植以胸骨对接方式重建胸锁关节，可使大多数因胸锁关节不稳定或因骨关节炎行内侧锁骨切除而需要手术的患者恢复稳定性。
