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
目的探讨采用PHILOS锁定钢板治疗肱骨近端粉碎性骨折的临床疗效。方法收集2010年1月至2012年6月应用PHILOS锁定钢板治疗16例肱骨近端骨折患者，通过影像学资料、Constant-Murley评分（Constant-Murley score，CMS）及美国肩肘外科医师（...目的探讨采用PHILOS锁定钢板治疗肱骨近端粉碎性骨折的临床疗效。方法收集2010年1月至2012年6月应用PHILOS锁定钢板治疗16例肱骨近端骨折患者，通过影像学资料、Constant-Murley评分（Constant-Murley score，CMS）及美国肩肘外科医师（ American shoulder and elbow surgeons, ASES） 评分对患者骨折愈合情况、肩关节功能及并发症等进行评估。结果16例患者均获随访，平均随访时间17（6～25）个月。16例（100％）患者获得骨性愈合，14例患者基本获得解剖复位（87．5％），1例（6．2％）患者术后肩关节轻度疼痛，1例（6．2％）患者术后肩关节功能严重障碍。所有病例无钢板螺钉断裂、肱骨头缺血性坏死发生；平均ASES评分为80．5（40～96）分，平均Constant评分为72．4（32-93）分；其中患肢肩关节功能优12例（75．0％）、良3例（18．8％）、差1例（6．2％）。结论采用PHILOS锁定钢板治疗肱骨近端粉碎型骨折，尤其对老年性骨质疏松患者，不仅可提供稳定的骨折固定，而且能进行早期功能锻炼，从而取得较好的疗效。展开更多
目的:探讨丁苏热桂外敷剂治疗肩锁关节炎(acromioclavicular joint ostesarthritis,ACJOA)的临床疗效。方法:选取2018年1月-2019年12月本院收治的60例ACJOA患者。采用随机数字表法将就诊患者分为对照组与观察组,各30例。对照组采用口服...目的:探讨丁苏热桂外敷剂治疗肩锁关节炎(acromioclavicular joint ostesarthritis,ACJOA)的临床疗效。方法:选取2018年1月-2019年12月本院收治的60例ACJOA患者。采用随机数字表法将就诊患者分为对照组与观察组,各30例。对照组采用口服塞来昔布胶囊治疗,观察组采用丁苏热桂外敷剂治疗。治疗2周后,观察两组的临床疗效,比较两组治疗前后视觉模拟评分(Visual Analogue Scale,VAS)、美国肩肘外科协会评分(rating scale of the American shoulder and elbow surgeons,ASES)、Constant-Murley评分(CMS)的变化情况。结果:观察组的总有效率为96.67%,高于对照组的83.33%,差异有统计学意义(P<0.05)。治疗后,两组VAS评分均低于治疗前,且观察组低于对照组,差异均有统计学意义(P<0.05)。治疗后,两组的ASES、CMS评分均高于治疗前,且观察组均高于对照组,差异均有统计学意义(P<0.05)。结论:丁苏热桂外敷剂能缓解肩锁关节炎患者的疼痛症状,增加肩关节活动度。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.
文摘目的探讨采用PHILOS锁定钢板治疗肱骨近端粉碎性骨折的临床疗效。方法收集2010年1月至2012年6月应用PHILOS锁定钢板治疗16例肱骨近端骨折患者，通过影像学资料、Constant-Murley评分（Constant-Murley score，CMS）及美国肩肘外科医师（ American shoulder and elbow surgeons, ASES） 评分对患者骨折愈合情况、肩关节功能及并发症等进行评估。结果16例患者均获随访，平均随访时间17（6～25）个月。16例（100％）患者获得骨性愈合，14例患者基本获得解剖复位（87．5％），1例（6．2％）患者术后肩关节轻度疼痛，1例（6．2％）患者术后肩关节功能严重障碍。所有病例无钢板螺钉断裂、肱骨头缺血性坏死发生；平均ASES评分为80．5（40～96）分，平均Constant评分为72．4（32-93）分；其中患肢肩关节功能优12例（75．0％）、良3例（18．8％）、差1例（6．2％）。结论采用PHILOS锁定钢板治疗肱骨近端粉碎型骨折，尤其对老年性骨质疏松患者，不仅可提供稳定的骨折固定，而且能进行早期功能锻炼，从而取得较好的疗效。
文摘目的:探讨丁苏热桂外敷剂治疗肩锁关节炎(acromioclavicular joint ostesarthritis,ACJOA)的临床疗效。方法:选取2018年1月-2019年12月本院收治的60例ACJOA患者。采用随机数字表法将就诊患者分为对照组与观察组,各30例。对照组采用口服塞来昔布胶囊治疗,观察组采用丁苏热桂外敷剂治疗。治疗2周后,观察两组的临床疗效,比较两组治疗前后视觉模拟评分(Visual Analogue Scale,VAS)、美国肩肘外科协会评分(rating scale of the American shoulder and elbow surgeons,ASES)、Constant-Murley评分(CMS)的变化情况。结果:观察组的总有效率为96.67%,高于对照组的83.33%,差异有统计学意义(P<0.05)。治疗后,两组VAS评分均低于治疗前,且观察组低于对照组,差异均有统计学意义(P<0.05)。治疗后,两组的ASES、CMS评分均高于治疗前,且观察组均高于对照组,差异均有统计学意义(P<0.05)。结论:丁苏热桂外敷剂能缓解肩锁关节炎患者的疼痛症状,增加肩关节活动度。
