Lee Brian K, Jamgochian Grant C, Syed Usman Ali M, Getz Charles L, Dodson Christopher C, Namdari Surena, Ramsey Matthew L, Williams Gerald R, Abboud Joseph A, Lazarus Mark D
Kerlan, Jobe Orthopaedic Clinic, USA.
Rothman Institute, Thomas Jefferson University, USA.
Arch Bone Jt Surg. 2019 May;7(3):239-245.
Reconstructions of acute acromioclavicular (AC) dislocations have been thought to result in superior outcomes than chronic dislocations. The use of tendon graft in reconstructions has demonstrated favorable biomechanical properties. To determine whether utilizing tendon graft during repair of acute AC dislocations results in superior outcomes and lower complication rate.
A retrospective review of AC reconstructions was conducted. Reconstructions performed within 3 weeks of injury were included. Inclusion criteria included age over 18, grade 3-5 AC joint separation, and no previous ipsilateral shoulder injury. Primary outcome measure was radiographic loss of reduction. Secondary outcomes included ASES and SANE scores.
Of 47 reconstructions of acute AC joint separations, 35 utilized fixation without a tendon graft, while 12 underwent an anatomic reconstruction with tendon graft. Repairs without the use of graft resulted in 8 (23%) cases of loss of reduction, while tendon graft augmented repairs resulted in 5 (42%). This difference was not statistically significant ( ). No patients required reoperation. There was no statistical difference in the ASES and SANE scores between the two groups. Furthermore, we found no significant difference in ASES or SANE scores in patients who maintained reduction postoperatively versus those that lost reduction.
A greater but not statistically significant rate of loss of reduction was observed in the group reconstructed with the use of a tendon graft. Further research is needed to determine whether the use of tendon graft is beneficial in the treatment of acute AC joint separations.
IV.
一直以来，人们认为急性肩锁关节（AC）脱位的重建手术比慢性脱位的手术效果更好。在重建手术中使用肌腱移植已显示出良好的生物力学性能。本研究旨在确定在急性AC脱位修复过程中使用肌腱移植是否能带来更好的治疗效果和更低的并发症发生率。
对AC关节重建手术进行回顾性分析。纳入伤后3周内进行的重建手术。纳入标准包括年龄超过18岁、AC关节分离3-5级以及既往同侧肩部无损伤。主要观察指标为影像学上复位丢失情况。次要观察指标包括ASES和SANE评分。
在47例急性AC关节分离重建手术中，35例采用无肌腱移植的固定术，12例采用肌腱移植的解剖重建术。未使用移植的修复手术中有8例（23%）出现复位丢失，而肌腱移植增强修复手术中有5例（42%）出现复位丢失。这种差异无统计学意义（ ）。无患者需要再次手术。两组之间的ASES和SANE评分无统计学差异。此外，我们发现术后维持复位的患者与复位丢失的患者在ASES或SANE评分上无显著差异。
在使用肌腱移植重建的组中观察到复位丢失率更高，但无统计学意义。需要进一步研究以确定使用肌腱移植在治疗急性AC关节分离中是否有益。
IV级。
