Biomedical Science and Engineering, National Chiao Tung University, No. 75, Bo'ai St., East Dist., Hsinchu City, 300, Taiwan, Republic of China.
Department of Orthopaedics, Mackay Memorial Hospital, Taipei, Taiwan.
BMC Musculoskelet Disord. 2020 Oct 23;21(1):701. doi: 10.1186/s12891-020-03726-z.
Acromioclavicular (AC) separation can be treated with the use of a hook plate. Some studies have reported that coracoclavicular (CC) ligament augmentation is necessary to reduce the complications of hook plate fixation, whereas others recommend hook plate fixation alone without augmentation. The aim of this study was to compare the results and complications between these two groups.
This was an observational case-control study. Patients with acute (less than 2 weeks) Rockwood type V AC separation were treated with a hook plate at our hospital. A total of 105 cases received hook plate fixation with CC ligament augmentation (group I), and 112 cases received hook plate fixation without augmentation (group II). Constant-Murley scores were used to evaluate the function before and after implant removal, and radiographs were taken to evaluate the complications. The results and complications were compared between groups.
Before removal, the Constant-Murley score was significantly higher in group I (mean, 50.1) than in group II (mean, 42.6) (p = 0.004); however, there was no significant difference between groups at 3 and 6 months after removal. The incidence of significant acromion osteolysis was higher in group II (65/112) than in group I (25/105). Before removal, the patients with significant acromion osteolysis had worse Constant-Murley scores than those of the patients without osteolysis in both groups. The incidence of peri-implant fracture of the hook plate was higher in group II (8/112) than in group I (1/105).
The patients without CC ligament augmentation had worse functional results before hook plate removal, a higher incidence of radiographic acromion osteolysis, and a higher incidence of peri-implant fractures than those patients with CC ligament augmentation. Therefore, CC ligament augmentation is highly recommended to improve short-term outcomes and decrease complications for Rockwood type V AC separation treated by hook plate.
肩锁关节（AC）分离可采用钩板治疗。一些研究报道，喙锁韧带（CC）增强是减少钩板固定并发症的必要手段，而另一些研究则建议单独使用钩板固定而不进行增强。本研究旨在比较这两组的结果和并发症。
这是一项观察性病例对照研究。我院收治的急性（2 周内）Rockwood Ⅴ型 AC 分离患者采用钩板治疗。共 105 例患者行钩板固定联合 CC 韧带增强（I 组），112 例患者行钩板固定不增强（II 组）。采用Constant-Murley 评分评估植入物取出前后的功能，并拍摄 X 线片评估并发症。比较两组的结果和并发症。
取出前，I 组 Constant-Murley 评分（平均 50.1）明显高于 II 组（平均 42.6）（p=0.004）；但取出后 3 个月和 6 个月时两组间无显著差异。II 组（65/112）显著肩峰骨溶解的发生率明显高于 I 组（25/105）。取出前，两组中肩峰骨溶解患者的 Constant-Murley 评分均明显低于无骨溶解患者。II 组（8/112）钩板周围骨折的发生率明显高于 I 组（1/105）。
与行 CC 韧带增强的患者相比，未行 CC 韧带增强的患者在钩板取出前功能结果较差，影像学肩峰骨溶解发生率较高，钩板周围骨折发生率较高。因此，对于 Rockwood Ⅴ型 AC 分离采用钩板治疗，强烈建议行 CC 韧带增强以改善短期结果并减少并发症。
