DeFoor Mikalyn T, Rizzo Michael G, Adriani Marco, Whalen Ryan J, Hurley Samuel C, Dickinson Nate J, Provencher Capt Matthew T
San Antonio Military Medical Center, Fort Sam Houston, Texas, U.S.A.
Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
Arthrosc Tech. 2025 Mar 4;14(6):103496. doi: 10.1016/j.eats.2025.103496. eCollection 2025 Jun.
Distal clavicle insufficiency, or a loss of the bony structure of the distal clavicle, generally after an injury or surgical procedure, may result in shoulder pain, dysfunction, scapular dyskinesia, and chronic acromioclavicular joint instability. If more than 15 to 20 mm of the distal clavicle is missing, chronic posterior instability of the distal clavicle may ensue and impinge on the deltotrapezial fascia and scapular spine. Although soft tissue reconstruction of the acromioclavicular-coracoclavicular (AC-CC) ligaments is a reliable procedure, if there is 15 to 20 mm or more of distal clavicle missing, it may be difficult to restore the mechanics of the scapular and glenohumeral joint. These can be seen after open or arthroscopic Mumford procedures (distal clavicle excision), AC-CC reconstructions with fracture, distal clavicle fractures, and other mechanisms. This technique article outlines an approach to distal clavicle insufficiency (>20 mm of missing distal clavicle bone) with iliac crest bone autograft reconstruction of the distal clavicle augmented with AC-CC soft tissue reconstruction.
锁骨远端缺损，即锁骨远端骨质结构缺失，通常发生在损伤或手术后，可能导致肩部疼痛、功能障碍、肩胛运动障碍以及慢性肩锁关节不稳定。如果锁骨远端缺失超过15至20毫米，可能会出现锁骨远端慢性后向不稳定，并压迫三角肌斜方肌筋膜和肩胛冈。尽管肩锁-喙锁（AC-CC）韧带的软组织重建是一种可靠的手术方法，但如果锁骨远端缺失15至20毫米或更多，可能难以恢复肩胛和盂肱关节的力学结构。这些情况可见于开放性或关节镜下芒福德手术（锁骨远端切除术）、骨折后的AC-CC重建、锁骨远端骨折以及其他损伤机制之后。本文技术文章概述了一种针对锁骨远端缺损（锁骨远端骨质缺失>20毫米）的治疗方法，即采用自体髂嵴骨移植重建锁骨远端，并辅以AC-CC软组织重建。
