Masionis Povilas, Bobina Rokas, Ryliskis Sigitas
Clinic of Rheumatology, Orthopaedics Traumatology and Reconstructive Surgery, Vilnius University Faculty of Medicine, Vilnius, LTU.
Faculty of Medicine, Vilnius University, Vilnius, LTU.
Cureus. 2020 Jan 16;12(1):e6681. doi: 10.7759/cureus.6681.
Background Acromioclavicular joint (ACJ) dislocation is a common injury among young and physically active persons. Evaluating surgical outcomes clinically and radiographically is widely accepted, but it is not known which clinical tests or radiological indicators are the most important. Our hypothesis is that there is a significant correlation between clinical and radiological findings and outcomes after the early surgical treatment of Tossy type III ACJ dislocation. Materials and methods A retrospective study was conducted on 23 patients who underwent early surgical treatment after Tossy type III ACJ dislocation. We used the constant score (CS) and the simple shoulder test (SST) to measure the outcomes. For clinical evaluation, Paxinos, O'Brien's, Bell-van Riet's, and horizontal adduction tests were used. Standard A-P view radiographs were evaluated for redislocation, ACJ arthrosis, coracoclavicular (CC) space ossification, and for the presence of osteolysis. Results The mean time of follow-up was 16 months (range, 12-22 months). During the follow-up, all patients had one or more pathological radiological signs. All clinical tests were negative in 12 patients, seven had one positive test, three had two positive tests, and one had three positive tests. The mean CS result at the follow-up was 93.44 ± 4.90 (range, 84-100), and the mean SST result was 10.78 ± 1.51 (range, 6-12). There was no statistically significant association between the CS results and either shoulder tests or radiological findings. The SST results were statistically significantly lower for patients with positive O'Brien's test compared to those with a negative one. In contrast, the SST results were statistically significantly higher for patients with CC space ossification, compared to those who did not have this radiological sign. Other clinical tests and radiological findings did not have any associations with the SST results. Conclusions We found that positive O'Brien's test was associated with worse outcomes of early surgical treatment after Tossy type III ACJ dislocation. Despite the presence of pathological radiological signs, patients may have good or even perfect clinical outcomes after the early surgical treatment of a Tossy type III injury.
背景 肩锁关节（ACJ）脱位是年轻且身体活跃人群中的常见损伤。临床上和影像学上评估手术效果已被广泛接受，但尚不清楚哪些临床检查或放射学指标最为重要。我们的假设是，Tossy III型ACJ脱位早期手术治疗后的临床和放射学表现与治疗效果之间存在显著相关性。
材料与方法 对23例Tossy III型ACJ脱位后接受早期手术治疗的患者进行了回顾性研究。我们使用Constant评分（CS）和简单肩关节试验（SST）来评估治疗效果。临床评估采用Paxinos试验、奥布赖恩试验、贝尔 - 范里特试验和水平内收试验。对标准前后位（A-P）X线片评估再脱位、ACJ关节病、喙锁（CC）间隙骨化情况以及是否存在骨质溶解。
结果 平均随访时间为16个月（范围12 - 22个月）。随访期间，所有患者均有一项或多项病理性放射学表现。12例患者所有临床检查均为阴性，7例有一项阳性检查，3例有两项阳性检查，1例有三项阳性检查。随访时CS的平均结果为93.44±4.90（范围84 - 100），SST的平均结果为10.78±1.51（范围6 - 12）。CS结果与肩关节检查或放射学表现之间无统计学显著关联。奥布赖恩试验阳性患者的SST结果在统计学上显著低于阴性患者。相反，CC间隙骨化患者的SST结果在统计学上显著高于无此放射学表现的患者。其他临床检查和放射学表现与SST结果均无关联。
结论 我们发现奥布赖恩试验阳性与Tossy III型ACJ脱位早期手术治疗效果较差相关。尽管存在病理性放射学表现，但Tossy III型损伤早期手术治疗后患者可能获得良好甚至完美的临床效果。
