Department of Orthopedic Surgery, Helwan University, Helwan, Egypt.
Department of Orthopedic Surgery, Benha University, Benha, Egypt.
Eur J Orthop Surg Traumatol. 2024 May;34(4):1795-1801. doi: 10.1007/s00590-023-03823-4. Epub 2024 Feb 28.
The most common cause of shoulder pain originating from the acromioclavicular (AC) joint is osteoarthritis, causing pain and disability. Operative Management of AC arthritis includes arthroscopic distal clavicle resection (DCR) and open clavicle resection. This study was conducted to evaluate the outcomes of isolated rotator cuff repair with conservative treatment of ACJ arthritis versus the combined resection of the distal clavicle with the repair of a rotator cuff tear, in cases with acromioclavicular arthritis.
A total of 46 patients with unilateral or bilateral combined rotator cuff tear and acromioclavicular arthritis were included, they were classified into 2 independent groups: Conservative group (23 patients), and DCR group (23 patients). All patients were subjected to full history taking, examination, pre and post-operative University of California at Los Angeles shoulder scoring scale (UCLA), Antero-Posterior and Zanca X-rays views, early and late complications.
Mean age was (51 ± 9) years, males were predominant (56.5%). The average post-operative UCLA score was (31.1 ± 4.9), and the average time to return to work was (214 ± 22). (2.2%) of patients had early complications, (19.6%) had late complications, (32.6%) had > 24 h till 1st post-operative analgesia, and (87%) needed MgSO4 Injection. We found a highly significant increase in UCLA score measurements in the Conservative group, and a highly significant increase in UCLA score measurements in the DCR group (p < 0.01). But there was no difference between the 2 groups.
Conventional conservative approach with arthroscopic rotator cuff repair and subacromial decompression has proven to be as effective as arthroscopic rotator cuff repair and subacromial decompression with DCR, in terms of efficacy and safety profiles in short term, but with more risks of potential hazards and cost with the DCR.
源自肩锁关节（AC）的肩痛最常见的原因是骨关节炎，引起疼痛和残疾。AC 关节炎的手术治疗包括关节镜下远端锁骨切除（DCR）和开放性锁骨切除。本研究旨在评估单纯肩袖修复联合保守治疗 ACJ 关节炎与联合切除远端锁骨合并肩袖撕裂修复治疗肩锁关节炎的疗效。
共纳入 46 例单侧或双侧合并肩袖撕裂和肩锁关节炎患者，分为 2 个独立组：保守组（23 例）和 DCR 组（23 例）。所有患者均进行详细的病史采集、检查、术前和术后加利福尼亚大学洛杉矶分校（UCLA）肩部评分量表（UCLA）、前后位和 Zanca X 线片、早期和晚期并发症。
平均年龄为（51±9）岁，男性为主（56.5%）。术后 UCLA 评分平均为（31.1±4.9），平均返岗时间为（214±22）天。（2.2%）的患者出现早期并发症，（19.6%）出现晚期并发症，（32.6%）术后 1 次镇痛需>24 小时，（87%）需要硫酸镁注射。我们发现保守组的 UCLA 评分测量有显著增加，DCR 组的 UCLA 评分测量有显著增加（p<0.01）。但两组间无差异。
在短期疗效和安全性方面，与 DCR 相比，关节镜下肩袖修复联合盂肱下松解的常规保守治疗与关节镜下肩袖修复联合 DCR 一样有效，但 DCR 有更多的潜在危害和成本风险。
