Suh Yu Min, Creighton R Alexander, Davidson Justin
Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Video J Sports Med. 2025 Jul 31;5(4):26350254251315503. doi: 10.1177/26350254251315503. eCollection 2025 Jul-Aug.
Distal clavicle resections are an effective treatment for subacromial impingement caused by clavicular pathologies. Causes include but are not limited to degenerative osteoarthritis, infection, malunion after trauma, and inflammatory arthritis. There are multiple variations of the procedure with different potential complications, including open and arthroscopic (direct, indirect).
In the setting of isolated acromioclavicular (AC) joint arthrosis, patients often have pain at the anterosuperior shoulder. Patients should be examined for tenderness to palpation at the AC joint in comparison to the unaffected side. This pain may increase with specific maneuvers to stress the AC joint, such as cross-body adduction, active compression, or maximal internal rotation. In addition to the standard 3 views of the shoulder, a Zanca view radiograph allows for optimal visualization of the AC joint.
The patient is placed upright in the beach-chair position, and the glenohumeral joint is accessed via the posterior and anterior portals. A soft tissue shaver and an ablation device are used to remove joint debris and capsule. Once the lateral clavicle is exposed, a bur is then introduced through the anterior portal. The proximal acromion and distal clavicle are then removed from anterior to posterior. A total of 6 to 7 mm of bone should be removed, which can be measured using the size of the bur. The camera is then switched to the anterior portal, and the resection can be completed with the bur in the posterior portal. This can accompany other subacromial decompression procedures or rotator cuff repair as needed.
The results of treating distal clavicle lesions via the above technique have been very successful in our patients. This is consistent with other studies in the literature, where patients with 20 years of follow-up were shown to have good outcomes after arthroscopic subacromial decompression. Patients who underwent arthroscopic rotator cuff repair with and without acromioplasty had a higher reoperation rate than those who did not undergo acromioplasty.
DISCUSSION/CONCLUSION: Distal clavicle resection is a safe and effective technique that can be easily employed as part of arthroscopic subacromial decompression.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
锁骨远端切除术是治疗由锁骨病变引起的肩峰下撞击症的有效方法。病因包括但不限于退行性骨关节炎、感染、创伤后骨不连和炎性关节炎。该手术有多种术式，存在不同的潜在并发症，包括开放手术和关节镜手术（直接、间接）。
在孤立性肩锁关节（AC）关节炎的情况下，患者通常在肩前部上方疼痛。应检查患者AC关节处与未受影响侧相比的触痛情况。这种疼痛可能会因特定的使AC关节受力的动作而加重，如体侧内收、主动压缩或最大程度内旋。除了肩部的标准3个视图外，Zanca位X线片可最佳显示AC关节。
患者取沙滩椅位直立，通过前后入路进入盂肱关节。使用软组织刨削器和消融设备清除关节碎屑和关节囊。一旦暴露锁骨外侧，通过前入路插入磨钻。然后从前向后切除近端肩峰和锁骨远端。总共应切除6至7毫米的骨质，可使用磨钻的尺寸进行测量。然后将摄像头切换至前入路，通过后入路的磨钻完成切除。根据需要，这可与其他肩峰下减压手术或肩袖修复术同时进行。
通过上述技术治疗锁骨远端病变在我们的患者中取得了非常成功的结果。这与文献中的其他研究一致，在那些研究中，随访20年的患者在关节镜下肩峰下减压术后显示出良好的效果。接受关节镜下肩袖修复术（无论是否行肩峰成形术）的患者比未行肩峰成形术的患者再次手术率更高。
讨论/结论：锁骨远端切除术是一种安全有效的技术，可轻松作为关节镜下肩峰下减压术的一部分应用。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本投稿附上患者的豁免声明或其他书面批准形式以供发表。
