Ranne Juha O, Kainonen Terho U, Lehtinen Janne T, Kanto Kari J, Vastamäki Heidi A, Kukkonen Mari K, Siitonen Mika T
Sports Trauma Research Unit, Hospital Mehiläinen Neo, Turku.
Paavo Nurmi Centre, Department of Physical Activity and Health, the University of Turku, Turku.
Arthrosc Sports Med Rehabil. 2020 Jan 8;2(1):e7-e15. doi: 10.1016/j.asmr.2019.10.003. eCollection 2020 Feb.
To determine the results of operatively treated chronic acromioclavicular (AC) joint dislocations after 2-year follow-up.
Fifty-eight patients with chronic acromioclavicular separations underwent arthroscopic coracoclavicular ligament reconstructions using semitendinosus autografts. Constant and Simple Shoulder Test scores were determined before and 2 years after surgery as a part of standard clinical practice. General patient satisfaction with the outcome (poor, fair, or excellent) also was assessed. In addition, for purposes of routine clinical follow-up, the coracoclavicular distance was measured from the inferior cortex of the clavicle to the superior cortex of the coracoid using anteroposterior radiographs taken 2 years after surgery. The results were compared with postoperative radiographs and changes in the distance were recorded. The clavicular drill hole was similarly measured 2 years after surgery to detect possible tunnel widening.
The mean preoperative Constant score increased from a preoperative mean of 52.6 ± 16.5 to 94.7 ± 7.9 at 2 years postoperatively ( = .000). The Simple Shoulder Test score increased from a preoperative mean of 7.7 ± 1.64 to 11.8 ± 0.7 ( = .000). The mean coracoclavicular distance increased from 10.5 ± 3.4 to 12.4 ± 3.9 mm ( = .009). The diameter of the clavicular drill hole increased from 6.0 mm to a mean of 8.4 mm. Two coracoid fractures were observed, but no clavicular fractures. One patient experienced a deep infection, leading to total reconstruction failure, and 2 patients had superficial postoperative infections. Forty-five patients (85%) reported excellent subjective outcomes, and 8 (15%) reported a fair outcome.
The outcomes of this series of coracoclavicular ligament reconstruction were favorable and the number of serious complications was small. However, clavicular wound issues were a significant problem. Coracoclavicular ligament reconstruction is a challenging procedure, but satisfactory results can be achieved with careful patient selection and good technique.
Level IV, therapeutic case series.
确定手术治疗慢性肩锁关节脱位2年随访后的结果。
58例慢性肩锁关节分离患者接受了关节镜下喙锁韧带重建术，采用半腱肌自体移植。作为标准临床实践的一部分，在手术前和术后2年测定Constant和简单肩部测试评分。还评估了患者对结果的总体满意度（差、一般或优秀）。此外，为了进行常规临床随访，在术后2年拍摄前后位X线片，测量从锁骨下皮质到喙突上皮质的喙锁距离。将结果与术后X线片进行比较，并记录距离变化。术后2年同样测量锁骨钻孔，以检测可能的隧道增宽。
术前Constant评分平均从52.6±16.5增加到术后2年的94.7±7.9（P = 0.000）。简单肩部测试评分从术前平均7.7±1.64增加到11.8±0.7（P = 0.000）。平均喙锁距离从10.5±3.4增加到12.4±3.9mm（P = 0.009）。锁骨钻孔直径从6.0mm增加到平均8.4mm。观察到2例喙突骨折，但无锁骨骨折。1例患者发生深部感染，导致重建完全失败，2例患者术后发生浅表感染。45例患者（85%）报告主观结果优秀，8例（15%）报告一般结果。
这一系列喙锁韧带重建的结果良好，严重并发症数量较少。然而，锁骨伤口问题是一个重大问题。喙锁韧带重建是一项具有挑战性的手术，但通过仔细选择患者和良好的技术可以取得满意的结果。
IV级，治疗性病例系列。
