Şahin Koray, Ertogrul Rodi, Kapıcıoğlu Mehmet, Erşen Ali, Bilsel Kerem
Faculty of Medicine, Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey.
Department of Orthopedics and Traumatology, Istanbul Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey.
JSES Int. 2022 Oct 30;7(1):113-120. doi: 10.1016/j.jseint.2022.10.001. eCollection 2023 Jan.
Recently, an emphasis has been put on anatomical reduction of acromioclavicular (AC) joint both in vertical and hortizontal planes for management of AC joint injuries due to persisting horizontal instability. Therefore, an additional AC fixation in horizontal plane has been recommended. However, relation between horizontal AC joint instability and clinical outcomes is still controversial. This study aims to evaluate outcomes of isolated coraco-clavicular fixation using arthroscopic assisted single coraco-clavicular tunnel technique in grade III and V AC joint injuries and to investigate the correlation between anatomical and clinical outcomes.
This study was conducted with 19 patients with grade III or V AC joint injury. Clinical outcomes included postoperative pain intensity and functional outcomes (Constant Score, American Shoulder and Elbow Surgeons, and Subjective Shoulder Value). Radiological evaluations were performed using radiographs and postoperative computed tomography scans. Degree of initial injury and postoperative stability both on axial and coronal planes were evaluated after radiological assessment. Correlations between anatomical and clinical outcomes were investigated using Pearson's correlation test.
At the final follow-up assessment, the mean pain score was 1.8 ± 1.8, mean American Shoulder and Elbow Surgeons score was 81.0 ± 15.4, mean Subjective Shoulder Value was 81.3 ± 19.6, and mean Constant Score was 86.3 ± 14.8. The mean loosening ratio and AC distance were 43.5 ± 30.6% and 4.3 ± 12.4 mm, respectively. No correlation was observed between postoperative anatomical and clinical outcomes ( > .05).
Additional AC fixation on horizontal plane is not a prerequisite for all injuries, there is no significant association between horizontal instability and clinical outcomes and indications of an additional AC fixation needs to be determined.
最近，由于持续存在的水平不稳定，肩锁关节（AC）损伤的治疗强调在垂直和水平平面上进行解剖复位。因此，建议在水平面上额外进行AC固定。然而，水平AC关节不稳定与临床结果之间的关系仍存在争议。本研究旨在评估关节镜辅助下单喙锁隧道技术在III级和V级AC关节损伤中单独进行喙锁固定的结果，并研究解剖学和临床结果之间的相关性。
本研究对19例III级或V级AC关节损伤患者进行。临床结果包括术后疼痛强度和功能结果（Constant评分、美国肩肘外科医师协会评分和主观肩关节评分）。使用X线片和术后计算机断层扫描进行影像学评估。在影像学评估后，评估初始损伤程度以及轴向和冠状面上的术后稳定性。使用Pearson相关检验研究解剖学和临床结果之间的相关性。
在最终随访评估中，平均疼痛评分为1.8±1.8，平均美国肩肘外科医师协会评分为81.0±15.4，平均主观肩关节评分为81.3±19.6，平均Constant评分为86.3±14.8。平均松动率和AC间距分别为43.5±30.6%和4.3±12.4mm。术后解剖学和临床结果之间未观察到相关性（>0.05）。
并非所有损伤都需要在水平面上额外进行AC固定，水平不稳定与临床结果之间无显著关联，额外AC固定的适应证需要确定。
