Kim Joo Yeon, Bryant Stewart, Gardner Brandon, Park Hee-Yon, Tse Whitney, Chakrabarti Moyukh, McGahan Patrick, Chen James L
Advanced Orthopaedics and Sports Medicine, San Francisco, California, U.S.A.
Arthrosc Tech. 2021 Jan 16;10(2):e359-e365. doi: 10.1016/j.eats.2020.10.010. eCollection 2021 Feb.
Pathology of the acromioclavicular joint is common and often resistant to conservative treatment, requiring distal clavicle excision for definitive relief. First described as an open technique by Mumford and Gurd in 1941, distal clavicle excision has evolved greatly, with arthroscopic techniques currently predominating. No significant difference has been found in patient satisfaction or rate of complication between the techniques in a recent meta-analysis. Indeed, open excisions are still performed at a high rate, owing to the difficulty in technique and visualization with arthroscopic methods. One major critique of arthroscopic distal clavicle excision is difficulty safeguarding against under- and overexcision of the distal clavicle due to the lack of depth perception and visual reference points of the arthroscopic perspective. This Technical Note and accompanying video describe an indirect subacromial arthroscopic distal clavicle excision using a fluoroscopic Kirschner wire guide placed at the proximal border prior to resection to serve as a visual and mechanical reference to overexcision.
肩锁关节病变很常见，且往往对保守治疗有抵抗性，需要切除锁骨远端才能获得确切缓解。1941年，芒福德和古德首次将其描述为一种开放技术，此后锁骨远端切除术有了很大发展，目前关节镜技术占主导地位。在最近的一项荟萃分析中，两种技术在患者满意度或并发症发生率方面未发现显著差异。事实上，由于关节镜技术操作难度大且可视化困难，开放切除术的实施率仍然很高。关节镜下锁骨远端切除术的一个主要批评是，由于缺乏关节镜视角的深度感知和视觉参考点，难以防止锁骨远端切除不足或过度切除。本技术说明及随附视频描述了一种间接肩峰下关节镜下锁骨远端切除术，即在切除前使用置于近端边界的透视克氏针导向器，作为防止过度切除的视觉和机械参考。
