Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC, USA.
Rush Health Systems, Meridian, MI, USA.
J Shoulder Elbow Surg. 2020 Jul;29(7S):S92-S100. doi: 10.1016/j.jse.2020.04.008.
The management of high-grade acromioclavicular separations remains unclear. The surgical interventions have shifted to more anatomic, less invasive techniques. The purpose of this study was to systematically review the outcomes and complications of anatomic coracoclavicular ligament reconstruction using a tendon graft.
Twenty-one studies (n = 460 patients) met the criteria for inclusion. A double clavicle tunnel tendon graft construct was used in 348 patients (75.7%), whereas a single clavicle tunnel technique was used in 112 patients (24.3%). No significant difference in loss of reduction was found between the 2 techniques. Of 460 patients, 96 (20.9%) demonstrated some form of radiographic displacement at the final follow-up. The overall complication rate was 21.3% (98 of 460), and a higher complication rate was found in the double clavicle tunnel technique (P < .001). The overall reoperation rate was 7.6% (37 of 460). The most common reason for reoperation was clavicle fracture (8 of 37). There was a statistically significant increase in reoperation when allograft was used (P = .003).
The results of this study suggest that despite newer techniques, approximately 20% of patients develop loss of reduction and/or experience a surgical complication. Attempts to minimize trauma to the clavicle and use autograft tendon may reduce the risk of reoperation.
高级肩锁关节分离的治疗仍不明确。手术干预已转向更具解剖学、侵袭性更小的技术。本研究旨在系统地回顾使用肌腱移植物进行解剖性喙锁韧带重建的结果和并发症。
21 项研究（n=460 例患者）符合纳入标准。348 例患者（75.7%）采用双锁骨隧道肌腱移植物构建，112 例患者（24.3%）采用单锁骨隧道技术。两种技术之间的复位丢失无显著差异。在 460 例患者中，96 例（20.9%）在最终随访时存在某种形式的影像学移位。总的并发症发生率为 21.3%（98/460），双锁骨隧道技术的并发症发生率更高（P<.001）。总的再次手术率为 7.6%（37/460）。再次手术的最常见原因是锁骨骨折（37 例中有 8 例）。使用同种异体移植物时，再次手术的风险显著增加（P=.003）。
本研究结果表明，尽管采用了新技术，但约 20%的患者会出现复位丢失和/或手术并发症。尽量减少对锁骨的创伤并使用自体肌腱移植物可能会降低再次手术的风险。
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