初次与翻修关节镜辅助肩锁和喙锁稳定术后慢性肩锁关节不稳时锁骨隧道的增宽情况
Clavicular tunnel widening in chronic acromioclavicular joint instabilities after primary versus revision arthroscopically-assisted acromio- and coracoclavicular stabilization.
作者信息
Vetter Philipp, Bellmann Frederik, Eckl Larissa, Lazaridou Asimina, Scheibel Markus
机构信息
Department of Traumatology University Hospital Zurich Zurich Switzerland.
Department of Shoulder and Elbow Surgery Schulthess Clinic Zurich Switzerland.
出版信息
J Exp Orthop. 2024 Sep 17;11(3):e12114. doi: 10.1002/jeo2.12114. eCollection 2024 Jul.
PURPOSE
To evaluate joint reduction (loss of reduction [LOR]; dynamic posterior translation [DPT]) and clavicular tunnel widening (cTW) in patients treated with arthroscopically-assisted acromioclavicular joint (ACJ) stabilization after previously failed nonoperative versus surgical treatment.
METHODS
Patients undergoing arthroscopically-assisted ACJ stabilization (bidirectional tendon allograft with a low-profile TightRope) after previously failed nonoperative versus surgical treatment were included retrospectively. Bilateral anteroposterior stress views served for evaluating LOR (side-comparative coracoclavicular distance [CCD]) and cTW at a 6-weeks- and 6-months-follow-up (FU) and for evaluating the filling ratio (FR, vertical device insertion depth relative to clavicle height) at the 6-weeks-FU. Postoperative DPT was assessed on Alexander's views.
RESULTS
Twenty-seven patients (20 male, mean age 46.1 ± 14.8 years) were included (prior treatment: nonoperative: = 15; surgical: = 12). There were no differences in LOR, DPT or cTW between groups postoperatively. Initial CCD-symmetry at the 6-weeks-FU (CCD: -0.1 mm [95% confidence interval, CI, -2 to 1.4 mm]) was followed by LOR at the 6-months-FU (CCD: -3.5 mm [95% CI, -5.2 to -1.9 mm]; < 0.001). cTW increased towards the inferior cortex, compared to the superior cortex and the intermediate level ( < 0.001, respectively). cTW at the inferior cortex was associated with more LOR ( = -0.449; = 0.024) and DPT ( = 0.421; = 0.036), dependent on a smaller FR ( = -0.430; = 0.032).
CONCLUSION
Patients undergoing arthroscopically-assisted ACJ stabilization for chronic bidirectional ACJ instabilities showed comparable radiologic results after previous nonoperative versus surgical treatment. cTW increased towards the inferior cortex and was associated with recurrent vertical and horizontal instability, related to a smaller FR. More research into reduced cTW, for example, by a more filling device, should be performed.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
目的
评估在非手术或手术治疗失败后接受关节镜辅助下肩锁关节（ACJ）稳定术治疗的患者的关节复位情况（复位丢失[LOR]；动态后向移位[DPT]）和锁骨隧道增宽（cTW）。
方法
回顾性纳入在非手术或手术治疗失败后接受关节镜辅助下ACJ稳定术（使用低调TightRope双向肌腱同种异体移植物）的患者。在6周和6个月随访（FU）时，采用双侧前后应力位片评估LOR（侧方比较喙锁间距[CCD]）和cTW，并在6周FU时评估填充率（FR，垂直装置插入深度相对于锁骨高度）。术后DPT通过亚历山大位片进行评估。
结果
纳入27例患者（20例男性，平均年龄46.1±14.8岁）（既往治疗：非手术：=15例；手术：=12例）。术后两组间LOR、DPT或cTW无差异。6周FU时初始CCD对称性（CCD：-0.1mm[95%置信区间，CI，-2至1.4mm]），随后6个月FU时出现LOR（CCD：-3.5mm[95%CI，-5.2至-1.9mm]；<0.001）。与上皮质和中间水平相比，cTW向下皮质增加（分别为<0.001）。下皮质的cTW与更多的LOR（=-0.449；=0.024）和DPT（=0.421；=0.036）相关，取决于较小的FR（=-0.430；=0.032）。
结论
因慢性双向ACJ不稳定接受关节镜辅助下ACJ稳定术治疗的患者，在既往非手术或手术治疗后，放射学结果相当。cTW向下皮质增加，并与复发性垂直和水平不稳定相关，与较小的FR有关。应开展更多关于减少cTW的研究，例如使用更具填充性的装置。
证据水平
III级，回顾性比较研究。
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