Vijayan S, Kulkarni M S, Jain C P, Shetty S, Aroor M N, Rao S K
Department of Orthopaedics, Kasturba Medical College Manipal - MAHE, Manipal, India.
Malays Orthop J. 2022 Nov;16(3):104-112. doi: 10.5704/MOJ.2211.016.
The acromioclavicular joint (ACJ) is a major link connecting the upper limb to the torso. The acromioclavicular and coracoclavicular (CC) ligaments help in stabilising the joint. We feel it is prudent to address both these ligament injuries, to achieve optimum result. This study was undertaken to analyse the results of a simple frugal surgical technique we used to deal with this injury considering stabilisation for both these ligaments.
In this retrospective study, skeletally mature patients with Type III, IV or V ACJ dislocations who underwent open reduction and stabilisation of the joint with temporary K-wires, repair of the capsule and augmentation of CC ligaments with suture anchors were included. Clinico-radiological and functional outcome was evaluated. Functional assessment of the upper limb was analysed using the Disabilities of Arm, Shoulder, and Hand Score (DASH), Constant shoulder score (CSS) and Oxford shoulder score (OSS).
Clinical and radiological evaluation of the 32 patients who had completed two years from the index surgery, was done. Out of the 37 patients included initially, five were lost in follow-up. Majority of the subjects included were males and type V was the most common injury. Mean pre-operative CC distance on the affected side was 13.92±4.94mm. In the immediate post-operative radiograph, it was 7.63±2.08mm and in the final follow- up was 9.36±2.75mm. Measurements were taken by two independent investigators and inter, and intra-observer reliability were analysed by Interclass correlation coefficient. Excellent functional outcome was noted despite the 1.81±1.50mm average loss of correction. At final follow-up, mean DASH score was 4.67±4.18, Oxford shoulder score was 44.06±2.44 and Constant shoulder score was 86.37±5.81. The severity of the injury had no significant effect on the functional outcome post our method of stabilisation and rehabilitation.
Bifocal fixation restores the multidirectional stability of the disrupted ACJ. Adequate radiological reduction, good functional outcome and simplicity of execution make this technique an undemanding one for use in regular practice.
肩锁关节（ACJ）是连接上肢与躯干的主要关节。肩锁韧带和喙锁韧带（CC）有助于稳定该关节。我们认为同时处理这两种韧带损伤是谨慎的做法，以获得最佳效果。本研究旨在分析一种简单经济的手术技术的结果，该技术用于处理这种损伤，同时考虑对这两种韧带进行稳定修复。
在这项回顾性研究中，纳入了骨骼成熟的III型、IV型或V型肩锁关节脱位患者，这些患者接受了切开复位，使用临时克氏针固定关节，修复关节囊并用缝合锚加强喙锁韧带。评估临床、放射学和功能结果。使用上肢、肩部和手部功能障碍评分（DASH）、Constant肩部评分（CSS）和牛津肩部评分（OSS）分析上肢的功能评估。
对32例自初次手术起已过去两年的患者进行了临床和放射学评估。最初纳入的37例患者中，5例失访。纳入的大多数受试者为男性，V型损伤最为常见。患侧术前平均喙锁间距为13.92±4.94mm。术后即刻X线片显示为7.63±2.08mm，最终随访时为9.36±2.75mm。测量由两名独立研究者进行，并通过组内相关系数分析观察者间和观察者内的可靠性。尽管平均矫正丢失1.81±1.50mm，但仍观察到良好的功能结果。在最终随访时，平均DASH评分为4.67±4.18，牛津肩部评分为44.06±2.44，Constant肩部评分为86.37±5.81。损伤的严重程度对我们的稳定修复和康复方法后的功能结果没有显著影响。
双焦点固定可恢复受损肩锁关节的多向稳定性。充分的放射学复位、良好的功能结果和操作的简单性使该技术在常规实践中易于应用。
