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
目的探讨麝香保心丸联合阿托伐他汀治疗急性冠脉综合征(ACS)患者的疗效及对血脂、血清基质金属蛋白酶8(MMP-8)和基质金属蛋白酶组织抑制因子1(TIMP-1)的影响。方法160例ACS患者随机分为观察组(n=80)和对照组(n=80)。对照组给予阿托伐他...目的探讨麝香保心丸联合阿托伐他汀治疗急性冠脉综合征(ACS)患者的疗效及对血脂、血清基质金属蛋白酶8(MMP-8)和基质金属蛋白酶组织抑制因子1(TIMP-1)的影响。方法160例ACS患者随机分为观察组(n=80)和对照组(n=80)。对照组给予阿托伐他汀治疗,观察组在对照组基础上给予麝香保心丸治疗。比较两组冠脉介入疗效,总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)及高密度脂蛋白胆固醇(HDL-C)等血脂指标水平,MMP-8、TIMP-1、C反应蛋白(CRP)和白细胞介素6(IL-6)等炎症因子水平,左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)、左心室舒张末期容积指数(LVEDVI)及左心室射血分数(LVEF)等心功能指标水平,以及30 d主要心血管不良事件(MACE)发生情况。结果两组冠脉介入治疗总有效率比较,差异无统计学意义(χ^(2)=1.56,P>0.05);治疗后,观察组TC、TG、LDL-C水平均明显低于对照组,HDL-C水平明显高于对照组(t分别=2.30、2.03、2.57、-3.64,P均<0.05),观察组血脂达标率为43.33%,明显高于对照组血脂达标率25.00%(χ^(2)=4.48,P<0.05);治疗后,观察组MMP-8、CRP、IL-6水平及LVESV、LVEDV、LVEDVI均明显低于对照组,TIMP-1水平、LVEF明显高于对照组(t分别=2.29、2.19、8.55、2.17、2.29、2.37、-2.97、-2.40,P均<0.05);两组30 d MACE发生率比较,差异无统计学意义(χ^(2)=0.12,P>0.05)。结论麝香保心丸联合阿托伐他汀治疗ACS患者可有效改善患者血脂、心功能及降低炎症水平,利于稳定斑块。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.
文摘目的探讨麝香保心丸联合阿托伐他汀治疗急性冠脉综合征(ACS)患者的疗效及对血脂、血清基质金属蛋白酶8(MMP-8)和基质金属蛋白酶组织抑制因子1(TIMP-1)的影响。方法160例ACS患者随机分为观察组(n=80)和对照组(n=80)。对照组给予阿托伐他汀治疗,观察组在对照组基础上给予麝香保心丸治疗。比较两组冠脉介入疗效,总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)及高密度脂蛋白胆固醇(HDL-C)等血脂指标水平,MMP-8、TIMP-1、C反应蛋白(CRP)和白细胞介素6(IL-6)等炎症因子水平,左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)、左心室舒张末期容积指数(LVEDVI)及左心室射血分数(LVEF)等心功能指标水平,以及30 d主要心血管不良事件(MACE)发生情况。结果两组冠脉介入治疗总有效率比较,差异无统计学意义(χ^(2)=1.56,P>0.05);治疗后,观察组TC、TG、LDL-C水平均明显低于对照组,HDL-C水平明显高于对照组(t分别=2.30、2.03、2.57、-3.64,P均<0.05),观察组血脂达标率为43.33%,明显高于对照组血脂达标率25.00%(χ^(2)=4.48,P<0.05);治疗后,观察组MMP-8、CRP、IL-6水平及LVESV、LVEDV、LVEDVI均明显低于对照组,TIMP-1水平、LVEF明显高于对照组(t分别=2.29、2.19、8.55、2.17、2.29、2.37、-2.97、-2.40,P均<0.05);两组30 d MACE发生率比较,差异无统计学意义(χ^(2)=0.12,P>0.05)。结论麝香保心丸联合阿托伐他汀治疗ACS患者可有效改善患者血脂、心功能及降低炎症水平,利于稳定斑块。
