Introduction: Acromioclavicular (AC) joint dislocation is a common shoulder injury, comprising 9% - 12% of shoulder girdle injuries. Optimal management remains challenging, with treatment decisions guided by the Rockw...Introduction: Acromioclavicular (AC) joint dislocation is a common shoulder injury, comprising 9% - 12% of shoulder girdle injuries. Optimal management remains challenging, with treatment decisions guided by the Rockwood classification system. Controversies surround grade III injuries, necessitating further classification. Non-operative treatment has shown favorable outcomes, while surgical interventions vary. Anatomical coracoclavicular reconstruction (ACCR) has demonstrated biomechanical advantages over traditional methods. Arthroscopic techniques offer advantages, minimizing deltoid detachment and allowing concurrent pathology identification. This study evaluates the outcomes of arthroscopic-assisted ACCR in chronic AC joint dislocation. Surgical Technique: Arthroscopic-assisted ACCR involves meticulous portal placement, tendon graft harvesting, diagnostic arthroscopy, and coracoid exposure. The clavicle tunnels were made to mimic the conoid and trapezoid ligament positions, using FibreTape#2 loop and Dog Bone Button for correct placement against the coracoid base, and passing the semitendinosus graft through to reconstruct the conoid ligament, reduction done and graft follow through for anatomical reconstruction. Methods: A retrospective cohort study at Hospital Kuala Lumpur analyzed 35 patients undergoing arthroscopic-assisted ACCR for Rockwood grade III - V AC joint dislocations. Inclusion criteria encompassed trauma ≥ 3 weeks prior, no prior shoulder injuries, and ≥12-month follow-up. Functional and radiological assessments utilized ASES scores and coracoclavicular distances, respectively. Statistical analysis employed descriptive statistics and logistic regression. Results: The mean age was 38.9 years (SD 11.26), and 34 of 35 patients were male. Grade IV injuries were predominant (37.1%). Waiting time for surgery averaged 234.9 days. Functional improvement was substantial postoperatively (ASES: 55.5 to 88.9). Radiological outcomes demonstrated reduced coracoclavicular distances and maintained reduction. No significant correlation was observed between injury grade and outcomes. Conclusion: Arthroscopic-assisted ACCR for chronic AC joint dislocation yields significant functional and radiological improvement, irrespective of injury grade. Waiting time for surgery exhibits minor impact on outcomes, emphasizing the procedure’s efficacy. Concomitant injuries do not impede success, highlighting the versatility of this approach in managing shoulder instability. The study contributes valuable insights into the nuanced management of chronic AC joint dislocations and supports the adoption of arthroscopic-assisted ACCR as a viable treatment option.展开更多
Objective:To explore the treatment of TOSSY type III acromioclavicular joint dislocation with clavicular hook plate combined with coracoclavicular ligament repair and its clinical effect.Methods:80 patients with TOSSY...Objective:To explore the treatment of TOSSY type III acromioclavicular joint dislocation with clavicular hook plate combined with coracoclavicular ligament repair and its clinical effect.Methods:80 patients with TOSSY type III acromioclavicular joint dislocation who were admitted to our hospital from January 2014 to January 2019 were selected.They were randomly divided into the control group(n=39,treated with clavicular hook plate)and the observation group(n=41,treated with clavicular hook plate combined with coracoclavicular ligament repair)by the random number table method.The clinical efficacy in 12 months after operation,related clinical indicators,12-month postoperative recovery and postoperative complications were compared between the two groups.Results:The excellent and good rate was 92.68%(38/41)in 12 months after operation in the observation group,which was higher than that(76.92%,30/39)in the control group(p<.05).There were no significant differences in the duration of surgery,intraoperative blood loss and HLOS between the observation group and the control group(p>.05).In 12 months after operation,abduction activity and forward flexion activity of the observation group were higher than those of the control group,and visual analogue score(VAS)was lower than that of the control group(p<.05).The incidence of complications in the observation group was slightly lower than that in the control group,but there was no statistically significant difference between the two groups(p>.05).Conclusions:For TOSSY type III acromioclavicular joint dislocation,clavicular hook plate combined with coracoclavicular ligament repair has a good clinical efficacy.It can improve shoulder joint function,alleviate shoulder pain and have fewer complications.It can provide a reference for clinical treatment of this type of acromioclavicular joint dislocation.展开更多
目的:比较双袢与“Y”形三袢TightRope纽扣钢板内固定治疗新鲜RockwoodⅢ~Ⅴ型肩锁关节脱位的临床疗效及安全性。方法:回顾性分析2016年1月至2019年5月收治的74例肩锁关节脱位患者的病例资料,其中采用双袢TightRope纽扣钢板内固定治疗...目的:比较双袢与“Y”形三袢TightRope纽扣钢板内固定治疗新鲜RockwoodⅢ~Ⅴ型肩锁关节脱位的临床疗效及安全性。方法:回顾性分析2016年1月至2019年5月收治的74例肩锁关节脱位患者的病例资料,其中采用双袢TightRope纽扣钢板内固定治疗者43例(双袢组),采用“Y”形三袢TightRope纽扣钢板内固定治疗者31例(三袢组)。比较2组患者的手术时间、喙锁间距差值、肩部疼痛视觉模拟量表(visual analogue scale,VAS)评分、加州大学洛杉矶分校(University of California Los Angeles,UCLA)肩关节量表评分、Constant-Murley肩关节评分及并发症发生率。结果:双袢组的手术时间短于三袢组[(31.37±4.03)min,(50.94±5.66)min,t=17.387,P=0.000)]。术后6周、24周、1年以及末次随访时,双袢组的喙锁间距差值均高于三袢组[(1.60±1.76)mm,(0.26±0.23)mm,t=4.220,P=0.000;(2.11±2.11)mm,(0.31±0.31)mm,t=4.695,P=0.000;(2.19±2.19)mm,(0.38±0.37)mm,t=4.536,P=0.000;(2.21±2.21)mm,(0.40±0.39)mm,t=4.499,P=0.000]。末次随访时,2组患者的肩部疼痛VAS评分均较术前降低(t=32.538,P=0.000;t=24.849,P=0.000),2组患者的肩部疼痛VAS评分比较,差异无统计学意义[(0.56±0.70)分,(0.55±0.72)分,t=0.058,P=0.954]。末次随访时,2组患者的UCLA肩关节量表评分均较术前增高(t=-108.72,P=0.000;t=-52.267,P=0.000),双袢组的UCLA肩关节量表评分低于三袢组[(47.02±1.71)分,(49.32±2.77)分,t=-2.490,P=0.015]。末次随访时,2组患者的Constant-Murley肩关节评分均较术前增高(t=-63.617,P=0.000;t=-67.607,P=0.000),双袢组的Constant-Murley肩关节评分低于三袢组[(94.58±2.70)分,(94.61±3.12)分,t=-2.135,P=0.036]。双袢组2例发生锁骨骨溶解,三袢组1例发生切口感染。2组患者并发症发生率比较,差异无统计学意义(P=1.000)。结论:双袢与“Y”形三袢TightRope纽扣钢板内固定治疗新鲜RockwoodⅢ~Ⅴ型肩锁关节脱位,均能减轻肩关节疼痛,但双袢固定的手术时间更短、“Y”形三袢固定的肩关节功能恢复得更好。展开更多
Purpose:Iatrogenic coracoid and clavicle fracture is a known complication of drilling bone tunnels during anatomic coracoclavicular ligament reconstruction(ACCR).This study aims to measure the dimensions of coracoid p...Purpose:Iatrogenic coracoid and clavicle fracture is a known complication of drilling bone tunnels during anatomic coracoclavicular ligament reconstruction(ACCR).This study aims to measure the dimensions of coracoid process and clavicle in an Asian population to evaluate the suitability of drilling coracoid and clavicle tunnels for ACCR in Asians.Methods:Width measurements of 196 coracoids and 189 clavicles were obtained after reviewing all computed tomography(CT)scans of the shoulder performed over a 6 years period.Coracoid measurements were made on the CT slice which showed the maximum cross sectional width of the coracoid base.Medial to lateral measurements of the coracoid width were taken on an axial view,4 mm above the identified junction of the coracoid base and glenoid base.Antero-posterior clavicle width was measured through a point directly above the midpoint of the coracoid and perpendicular to the long axis of the clavicle.Results:The overall mean coracoid width was 14.8 mm±2.54 mm(range 9.2e23.3 mm)and clavicle width was 17.1 mm±2.72 mm(range 11.1e25.3 mm).Conclusion:The Asian coracoid process is smaller than its Western equivalent.More research is required to validate this conclusion as no cadaveric studies with equivalent measurement techniques have been performed on Asians.Given the potentially narrower dimensions of the Asian coracoid process,extra precautions are required to minimize the risk of iatrogenic coracoid and clavicle fractures.展开更多
文摘Introduction: Acromioclavicular (AC) joint dislocation is a common shoulder injury, comprising 9% - 12% of shoulder girdle injuries. Optimal management remains challenging, with treatment decisions guided by the Rockwood classification system. Controversies surround grade III injuries, necessitating further classification. Non-operative treatment has shown favorable outcomes, while surgical interventions vary. Anatomical coracoclavicular reconstruction (ACCR) has demonstrated biomechanical advantages over traditional methods. Arthroscopic techniques offer advantages, minimizing deltoid detachment and allowing concurrent pathology identification. This study evaluates the outcomes of arthroscopic-assisted ACCR in chronic AC joint dislocation. Surgical Technique: Arthroscopic-assisted ACCR involves meticulous portal placement, tendon graft harvesting, diagnostic arthroscopy, and coracoid exposure. The clavicle tunnels were made to mimic the conoid and trapezoid ligament positions, using FibreTape#2 loop and Dog Bone Button for correct placement against the coracoid base, and passing the semitendinosus graft through to reconstruct the conoid ligament, reduction done and graft follow through for anatomical reconstruction. Methods: A retrospective cohort study at Hospital Kuala Lumpur analyzed 35 patients undergoing arthroscopic-assisted ACCR for Rockwood grade III - V AC joint dislocations. Inclusion criteria encompassed trauma ≥ 3 weeks prior, no prior shoulder injuries, and ≥12-month follow-up. Functional and radiological assessments utilized ASES scores and coracoclavicular distances, respectively. Statistical analysis employed descriptive statistics and logistic regression. Results: The mean age was 38.9 years (SD 11.26), and 34 of 35 patients were male. Grade IV injuries were predominant (37.1%). Waiting time for surgery averaged 234.9 days. Functional improvement was substantial postoperatively (ASES: 55.5 to 88.9). Radiological outcomes demonstrated reduced coracoclavicular distances and maintained reduction. No significant correlation was observed between injury grade and outcomes. Conclusion: Arthroscopic-assisted ACCR for chronic AC joint dislocation yields significant functional and radiological improvement, irrespective of injury grade. Waiting time for surgery exhibits minor impact on outcomes, emphasizing the procedure’s efficacy. Concomitant injuries do not impede success, highlighting the versatility of this approach in managing shoulder instability. The study contributes valuable insights into the nuanced management of chronic AC joint dislocations and supports the adoption of arthroscopic-assisted ACCR as a viable treatment option.
基金Natural Science Foundation of Inner Mongolia Autonomous Region(2019MS08045).
文摘Objective:To explore the treatment of TOSSY type III acromioclavicular joint dislocation with clavicular hook plate combined with coracoclavicular ligament repair and its clinical effect.Methods:80 patients with TOSSY type III acromioclavicular joint dislocation who were admitted to our hospital from January 2014 to January 2019 were selected.They were randomly divided into the control group(n=39,treated with clavicular hook plate)and the observation group(n=41,treated with clavicular hook plate combined with coracoclavicular ligament repair)by the random number table method.The clinical efficacy in 12 months after operation,related clinical indicators,12-month postoperative recovery and postoperative complications were compared between the two groups.Results:The excellent and good rate was 92.68%(38/41)in 12 months after operation in the observation group,which was higher than that(76.92%,30/39)in the control group(p<.05).There were no significant differences in the duration of surgery,intraoperative blood loss and HLOS between the observation group and the control group(p>.05).In 12 months after operation,abduction activity and forward flexion activity of the observation group were higher than those of the control group,and visual analogue score(VAS)was lower than that of the control group(p<.05).The incidence of complications in the observation group was slightly lower than that in the control group,but there was no statistically significant difference between the two groups(p>.05).Conclusions:For TOSSY type III acromioclavicular joint dislocation,clavicular hook plate combined with coracoclavicular ligament repair has a good clinical efficacy.It can improve shoulder joint function,alleviate shoulder pain and have fewer complications.It can provide a reference for clinical treatment of this type of acromioclavicular joint dislocation.
文摘目的:比较双袢与“Y”形三袢TightRope纽扣钢板内固定治疗新鲜RockwoodⅢ~Ⅴ型肩锁关节脱位的临床疗效及安全性。方法:回顾性分析2016年1月至2019年5月收治的74例肩锁关节脱位患者的病例资料,其中采用双袢TightRope纽扣钢板内固定治疗者43例(双袢组),采用“Y”形三袢TightRope纽扣钢板内固定治疗者31例(三袢组)。比较2组患者的手术时间、喙锁间距差值、肩部疼痛视觉模拟量表(visual analogue scale,VAS)评分、加州大学洛杉矶分校(University of California Los Angeles,UCLA)肩关节量表评分、Constant-Murley肩关节评分及并发症发生率。结果:双袢组的手术时间短于三袢组[(31.37±4.03)min,(50.94±5.66)min,t=17.387,P=0.000)]。术后6周、24周、1年以及末次随访时,双袢组的喙锁间距差值均高于三袢组[(1.60±1.76)mm,(0.26±0.23)mm,t=4.220,P=0.000;(2.11±2.11)mm,(0.31±0.31)mm,t=4.695,P=0.000;(2.19±2.19)mm,(0.38±0.37)mm,t=4.536,P=0.000;(2.21±2.21)mm,(0.40±0.39)mm,t=4.499,P=0.000]。末次随访时,2组患者的肩部疼痛VAS评分均较术前降低(t=32.538,P=0.000;t=24.849,P=0.000),2组患者的肩部疼痛VAS评分比较,差异无统计学意义[(0.56±0.70)分,(0.55±0.72)分,t=0.058,P=0.954]。末次随访时,2组患者的UCLA肩关节量表评分均较术前增高(t=-108.72,P=0.000;t=-52.267,P=0.000),双袢组的UCLA肩关节量表评分低于三袢组[(47.02±1.71)分,(49.32±2.77)分,t=-2.490,P=0.015]。末次随访时,2组患者的Constant-Murley肩关节评分均较术前增高(t=-63.617,P=0.000;t=-67.607,P=0.000),双袢组的Constant-Murley肩关节评分低于三袢组[(94.58±2.70)分,(94.61±3.12)分,t=-2.135,P=0.036]。双袢组2例发生锁骨骨溶解,三袢组1例发生切口感染。2组患者并发症发生率比较,差异无统计学意义(P=1.000)。结论:双袢与“Y”形三袢TightRope纽扣钢板内固定治疗新鲜RockwoodⅢ~Ⅴ型肩锁关节脱位,均能减轻肩关节疼痛,但双袢固定的手术时间更短、“Y”形三袢固定的肩关节功能恢复得更好。
文摘Purpose:Iatrogenic coracoid and clavicle fracture is a known complication of drilling bone tunnels during anatomic coracoclavicular ligament reconstruction(ACCR).This study aims to measure the dimensions of coracoid process and clavicle in an Asian population to evaluate the suitability of drilling coracoid and clavicle tunnels for ACCR in Asians.Methods:Width measurements of 196 coracoids and 189 clavicles were obtained after reviewing all computed tomography(CT)scans of the shoulder performed over a 6 years period.Coracoid measurements were made on the CT slice which showed the maximum cross sectional width of the coracoid base.Medial to lateral measurements of the coracoid width were taken on an axial view,4 mm above the identified junction of the coracoid base and glenoid base.Antero-posterior clavicle width was measured through a point directly above the midpoint of the coracoid and perpendicular to the long axis of the clavicle.Results:The overall mean coracoid width was 14.8 mm±2.54 mm(range 9.2e23.3 mm)and clavicle width was 17.1 mm±2.72 mm(range 11.1e25.3 mm).Conclusion:The Asian coracoid process is smaller than its Western equivalent.More research is required to validate this conclusion as no cadaveric studies with equivalent measurement techniques have been performed on Asians.Given the potentially narrower dimensions of the Asian coracoid process,extra precautions are required to minimize the risk of iatrogenic coracoid and clavicle fractures.
