Department for Orthopaedic Surgery and Traumatology, DIAKOVERE Friederikenstift, Humboldtstraße 5, 30169, Hannover, Germany.
Department for Orthopaedic Surgery, Medical School Hannover, DIAKOVERE Annastift, Anna-von-Borries-Straße 1-7, 30625, Hannover, Germany.
Eur J Orthop Surg Traumatol. 2023 May;33(4):1185-1192. doi: 10.1007/s00590-022-03271-6. Epub 2022 May 7.
Purpose of this study was to demonstrate that a single tunnel reconstruction of high-grade acromioclavicular (AC) joint instabilities with implants of the second generation is sufficient for stabilisation, especially in combination with an AC cerclage.
Patients with an acute AC-joint dislocation type Rockwood III-B and V were included. Besides clinical follow-up examination, radiographs were analysed. The functional outcome measures were Constant Score (CS), Taft score (TS), ACJI score and patient's satisfaction. Horizontal instability was evaluated by clinical examination and radiological with an Alexander view.
Thirty-five patients with a mean follow-up of 29 months were included. Ninety-seven per cent were satisfied with their result, with an average Subjective Shoulder Value of 90%. The CS averaged at 90 ± 10 points, TS at 11 ± 1 points and ACJI at 78 ± 18 points. Radiologically, 3 of 29 patients (10%) showed a persisting horizontal instability. The coracoclavicular (CC) distance improved from 22 preoperative to 10 mm postoperative, which was comparable to the contralateral side (10 mm, p = 0.103). At follow-up the CC distance increased to 13 mm (p = 0.0001).
AC-joint stabilisation with a single tunnel reconstruction using a second-generation implant results in good to excellent clinical results with high patient satisfaction. The additional AC augmentation improves stability in horizontal instable AC-joints and is recommended in all high-grade AC joint stabilisations. Nonetheless, reduction was slightly lost over time due to an elongation or suture failure of the coraco-clavicular fixation.
IV.
本研究旨在证明使用第二代植入物进行单个隧道重建即可充分稳定高等级肩锁关节（AC）不稳，特别是与 AC 环扎术联合使用时。
纳入急性 AC 关节脱位 Rockwood III-B 和 V 型患者。除临床随访检查外，还分析了影像学资料。功能评估采用 Constant 评分（CS）、Taft 评分（TS）、ACJI 评分和患者满意度。通过临床检查和 Alexander 位 X 线评估水平不稳定性。
共纳入 35 例患者，平均随访 29 个月。97%的患者对治疗结果满意，平均主观肩部值为 90%。CS 平均为 90±10 分，TS 平均为 11±1 分，ACJI 平均为 78±18 分。影像学上，29 例患者中有 3 例（10%）存在持续的水平不稳定性。喙锁间距从术前的 22mm 改善至术后 10mm，与对侧相比无差异（p=0.103）。随访时，喙锁间距增加至 13mm（p=0.0001）。
使用第二代植入物进行单个隧道重建可稳定 AC 关节，获得良好到优秀的临床效果，患者满意度高。AC 加强可提高水平不稳定 AC 关节的稳定性，建议在所有高等级 AC 关节稳定术中使用。然而，由于喙锁固定的延长或缝线失效，复位会随时间逐渐丢失。
IV。
