Department of Trauma Hand and Reconstructive Surgery Ulm University, Albert-Einstein-Allee 23, Ulm, 89081, Germany.
Eur J Trauma Emerg Surg. 2024 Oct;50(5):2431-2439. doi: 10.1007/s00068-024-02582-z. Epub 2024 Jul 12.
The surgical treatment of acute traumatic AC joint dislocations is still a subject of scientific debate in the literature. The arthroscopically assisted stabilization procedure with a suture button system has been successfully established and is widely used in daily practice. It is minimally invasive and allows the anatomical reconstruction of the torn coracoclavicular ligaments in one step with a permanent implant that does not have to be removed in a second operation. This clinical pilot study is the first to describe the new method of navigated suture button implantation with the future aim of further reducing surgical invasiveness and further increasing surgical precision.
10 patients with a Rockwood 3b/5 injury could be included in the prospective study (DRKS00031855) within 5 months according to inclusion and exclusion criteria. Surgical stabilization was performed with a suture button system via a navigated coracoclavicular drill tunnel. Demographic and radiological data as well as information on health and shoulder function were collected from patient records, X-rays, DVT scan and 3 questionnaires (DASH, NHS and Eq. 5D) at the preoperative, intraoperative and postoperative (discharge, 6 weeks and 3 months) time points.
All operations could be performed within 8.8 days (± 6.81) after trauma. The average operation time was 50.3 min (± 8.81). The mean distance of the drill hole in the clavicle to the AC joint was 26.6 mm (± 2.63). The radiologically measured vertical coracoclavicular distance was 38.8 mm (± 6.16) at discharge and 41.11 mm (± 7.51) at 3 months. This loss of reduction was not statistically significant. In contrast, the DASH, NHS and Eq. 5D results showed significant improvement from discharge to 3 months postoperatively.
Image-guided 3D C-arm navigated AC joint suture button stabilization is feasible in everyday surgical practice. It may be possible to achieve a further reduction in invasiveness while at the same time increasing the accuracy of implant positioning. Further clinical studies with a larger number of patients and a longer follow-up period are necessary to enable a comparison with conventional methods.
急性创伤性肩锁关节脱位的手术治疗仍是文献中一个具有争议的话题。关节镜辅助下缝合纽扣系统固定术已成功建立并广泛应用于临床实践中。这种方法具有微创性，可以一步实现撕裂的喙锁韧带的解剖重建，并使用永久性植入物固定，无需在二次手术中取出。本临床初步研究首次描述了新的导航缝合纽扣植入方法，其未来目标是进一步降低手术的侵袭性，并进一步提高手术的精确性。
根据纳入和排除标准，在 5 个月内，前瞻性研究（DRKS00031855）纳入了 10 例 Rockwood 3b/5 损伤患者。通过导航喙锁钻孔隧道，使用缝合纽扣系统进行手术固定。从患者病历、X 射线、深静脉血栓扫描和 3 份问卷（DASH、NHS 和 Eq.5D）中收集人口统计学和影像学数据以及健康和肩部功能信息，分别在术前、术中及术后（出院时、6 周和 3 个月）进行评估。
所有手术均在创伤后 8.8 天（±6.81）内完成。平均手术时间为 50.3 分钟（±8.81）。锁骨上钻孔的平均距离为肩锁关节 26.6 毫米（±2.63）。出院时，影像学测量的垂直喙锁间距为 38.8 毫米（±6.16），3 个月时为 41.11 毫米（±7.51）。这种复位丢失没有统计学意义。相比之下，DASH、NHS 和 Eq.5D 结果显示术后 3 个月与出院时相比有显著改善。
在日常手术实践中，图像引导的 3D C 臂导航肩锁关节缝合纽扣固定是可行的。在不增加手术侵袭性的同时，有可能提高植入物定位的准确性。需要进行更多患者数量和更长随访时间的临床研究，以便与传统方法进行比较。
