BACKGROUND Acromioclavicular joint(ACJ)space narrowing has been considered to be an important diagnostic image parameter of ACJ osteoarthritis(ACJO).However,the morphology of the ACJ space is irregular because of oste...BACKGROUND Acromioclavicular joint(ACJ)space narrowing has been considered to be an important diagnostic image parameter of ACJ osteoarthritis(ACJO).However,the morphology of the ACJ space is irregular because of osteophyte formation,subchondral irregularity,capsular distention,sclerosis,and erosion.Therefore,we created the ACJ cross-sectional area(ACJCSA)as a new diagnostic image parameter to assess the irregular morphologic changes of the ACJ.AIM To hypothesize that the ACJCSA is a new diagnostic image parameter for ACJO.METHODS ACJ samples were obtained from 35 patients with ACJO and 30 healthy individuals who underwent shoulder magnetic resonance(S-MR)imaging that revealed no evidence of ACJO.Oblique coronal,T2-weighted,fat-suppressed SMR images were acquired at the ACJ level from the two groups.We measured the ACJCSA and the ACJ space width(ACJSW)at the ACJ on the S-MR images using our imaging analysis program.The ACJCSA was measured as the cross-sectional area of the ACJ.The ACJSW was measured as the narrowest point between the acromion and the clavicle.RESULTS The average ACJCSA was 39.88±10.60 mm;in the normal group and 18.80±5.13 mm;in the ACJO group.The mean ACJSW was 3.51±0.58 mm in the normal group and 2.02±0.48 mm in the ACJO group.ACJO individuals had significantly lower ACJCSA and ACJSW than the healthy individuals.Receiver operating characteristic curve analyses demonstrated that the most suitable ACJCSA cutoff score was 26.14 mm^(2),with 91.4%sensitivity and 90.0%specificity.CONCLUSION The optimal ACJSW cutoff score was 2.37 mm,with 88.6%sensitivity and 96.7%specificity.Even though both the ACJCSA and ACJSW were significantly associated with ACJO,the ACJCSA was a more sensitive diagnostic image parameter.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
Objective: To propose an original method of surgical treatment for the acromial extremity of the clavicle rupture(Rockwood II-VI) with modeled Kirschner wire and cortical screw. Methods: Anatomical study and a test me...Objective: To propose an original method of surgical treatment for the acromial extremity of the clavicle rupture(Rockwood II-VI) with modeled Kirschner wire and cortical screw. Methods: Anatomical study and a test method were applied to 43 cadavers of both sexes. During the period between 2000 and 2013, 34 patients of both sexes were operated upon using the new method. In the comparison group(n = 120), the fixation of the acromial extremity of the clavicle rupture was performed with hamate plate, Lee hook and Kirschner wires.Results: Its application allows, according to the evaluation scale of Constant and Murley(1987), 10% more preservation of the function of the shoulder compared with traditional methods of surgical treatment, and shortens the required hospital treatment and temporary disability periods.Conclusions: It is shown that the proposed author's method combines low invasiveness, minimum dimensions of the construction and low-cost treatment.展开更多
Purpose: Acromioclavicular (AC) joint dislocation is commonly treated using a clavicle hook plate (HP). However, previous reports have indicated that acromial fractures may occur after HP fixation. The purpose of this...Purpose: Acromioclavicular (AC) joint dislocation is commonly treated using a clavicle hook plate (HP). However, previous reports have indicated that acromial fractures may occur after HP fixation. The purpose of this study was to identify risk factors for acromial fractures. Methods: A retrospective study was conducted on 39 patients with AC joint dislocation who were treated using clavicle HP fixation in our hospital between 2006 and 2017. Related parameters, including Rockwood classification, hook angle, the degree of reduction, the coverage of the hook under the acromion, and the anteroposterior position of the hook under the acromion, were evaluated to identify risk factors for acromial fractures. Results: The mean age of the participants was 51.7 (range 19 - 81) years;34 were men and 5 were women. Injury occurred on the right side in 18 patients and on the left side in 21. Injuries were categorized as follows: 24 were Rockwood type III, one was type IV, and 14 were type V. Four of the 39 patients (10%) experienced acromial fractures. Statistical analyses indicated that the degree of reduction at the final follow-up was moderately correlated with the Constant score. Posterior positioning of the hook was the only identified risk factor for acromial fractures. Hook angle and the degree of reduction at the time of surgery were not significantly associated with acromial fractures. Conclusions: Postoperative shoulder function was associated with the degree of reduction at the final follow-up, suggesting that anatomical reduction is recommended for AC joint dislocation. Posterior positioning of the hook is a risk factor for acromial fractures;however, clavicle HP fixation provides a positive outcome for AC joint dislocation. Therefore, careful positioning of the hook is required for preventing acromial fractures.展开更多
Introduction: The acromioclavicular joint is a superficial diarthrodial joint that surrounds the medial articular facet of the acromion and the distal portion of the clavicle. Due to its anatomy and biomechanics, it i...Introduction: The acromioclavicular joint is a superficial diarthrodial joint that surrounds the medial articular facet of the acromion and the distal portion of the clavicle. Due to its anatomy and biomechanics, it is highly susceptible to trauma and in young men who play contact sports, acromioclavicular dislocation is common. This article aimed to systematically review the literature and compare the surgical techniques used in the treatment of acromioclavicular dislocation in patients who practice sports. Methods: This systematic review was conducted according to the International Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Eligible studies for this systematic review included articles in English or Spanish published between 2013 and 2023, which mention the occurrence of acromioclavicular dislocation during sports practices. Additionally, only studies that addressed the surgical treatment of acromion-clavicular dislocation and contained original data on the topic were included. Results: We found 144 eligible studies after searching the LILACS and PubMed databases. Based on the inclusion and exclusion criteria and the reviewers’ consensus, we selected four studies for the systematic review. 133 patients with AC joint displacement were evaluated. Mean Age: approximately 31.90 years. 81.92 of these injuries occurred during sports practice. Surgical Procedures Used: titanium plates fixation (49 patients), arthroscopy (24), single tunnel technique (30) and coracoid sling technique (30). The results of the visual analog scale and Constant-Murley scores varied between the techniques used. Twenty-two complications after surgical treatment were identified. Conclusion: A significant variability of operative techniques can be used in the surgical approach of acromioclavicular dislocation, such as arthroscopy, single tunnel, coracoid sling and titanium plates. Although it presented excellent functional results compared to the other three techniques evaluated by this review, using titanium plates is not the gold standard since other techniques not assessed by this work may be more effective.展开更多
Objective:To comparatively study complete dislo cation of acromioclavicular joint treated with three different methods. Methods:A total of 96 patients (81 males and 15 females, aged 16-59 years, mean=45 years) with co...Objective:To comparatively study complete dislo cation of acromioclavicular joint treated with three different methods. Methods:A total of 96 patients (81 males and 15 females, aged 16-59 years, mean=45 years) with complete dislocation of acromioclavicular join t were treated with Dewars operation (Group A, n=32), internal fixation with K irschner tension band wires (Group B, n=44), or internal fixation with Wolter pl ates (Group C, n=20), respectively, in this study. Eighty-five patients suffere d from acute dislocations and eleven from chronic dislocations. Results:The patients were followed up for 50 months on an aver age. According to Karlssons standard, in Group A, 26 patients were assessed as good, 5 as fair and 1 as poor. In Group B, 20 patients were assessed as good, 1 3 as fair and 11 as poor. In Group C, 15 patients were assessed as good, 4 as fa ir and 1 as poor. The good and fair rates were significantly different between G roup A and Group B, and between Group C and Group B, but no statistical differen ce was found between Group A and Group C. The operating time was ( 52.36 ± 7 .24 ) minutes, ( 67.43 ± 8.11 ) minutes and ( 69.73 ± 8.04 ) minutes in Groups A, B and C, respectively. And the hospitalizing fees were ( 2 400 ± 270) yuan, ( 2 100 ±190) yuan and ( 8 450 ±360) yuan in Groups A, B and C, respectively. Conclusions:Dewars operation is a good and safe method with shorter operating time and lower hospitalizing fee for treating complete disloca tion of acromioclavicular joint. The method is simple without the need of a seco nd operation to remove the implants and with few complications.展开更多
Objective：To evaluate clinical outcome of suture anchors in strengthening both acromioclavicular and coracoclavicular ligaments in the surgical treatment of acromioclavicular joint dislocation.Methods：Twenty-eight p...Objective：To evaluate clinical outcome of suture anchors in strengthening both acromioclavicular and coracoclavicular ligaments in the surgical treatment of acromioclavicular joint dislocation.Methods：Twenty-eight patients with acute traumatic Rockwood Ⅲ,Ⅳ and Ⅴ dislocations of the acromioclavicular joint surgically treated at our institute between October 2010 and January 2012 were recruited.All patients underwent open reduction combined with suture anchors.Function was evaluated using the ConstantMurley shoulder score.Clinical and radiographic shoulder ratings were evaluated using Taft criteria at 3,6 and 12 months.Results：Two cases with fixation loosening were not included in final statistical analysis.Other patients obtained full joint reposition on immediate postoperative radiographs.Follow-up was performed with an average of 15.6 months （range,12-19）.After early range of motion exercises,96.2％ of the patients （25/26） could abduct and elevate their shoulders more than 90 degrees within postoperative 3 months.There was no infection.Average Constant-Murley score was 96.3 points （range,94-100）and mean Taft shoulder rating was 10.7 points （range,8-12） at 12 months.Conclusion：The suture anchor is a relatively simple technique and can avoid screw removal which is helpful in reconstructing both acromioclavicular and coracoclavicular ligaments in acute traumatic acromioclavicular joint dislocation.展开更多
Objective: To report a new method of coracoid transposition for the treatment of complete dislocation of acromioclavicular joint and to evaluate its efficacy. Methods: We modified Dewar’s surgical method as follows: ...Objective: To report a new method of coracoid transposition for the treatment of complete dislocation of acromioclavicular joint and to evaluate its efficacy. Methods: We modified Dewar’s surgical method as follows: (1) Two small incisions, a transversal incision on the acromioclavicular joint and a longitudinal incision on the coracoid, were made instead of a conventional large arc incision from the acromion to coracoid. (2) The foreign body in the acromioclavicular joint was cleared out. The chondral surface at the lateral segment of clavicle was resected to form a pseudarthrosis and meanwhile the residual joint capsule and ligaments were repaired. (3) The coracoid was moved to the anteroinferior edge of the clavicle instead of the anterior margin and (4) the coracoid was moved to the lateral border of the clavicle instead of the superior border of the coracoclavicular ligament. Results: The follow up duration in 30 patients of the series was from 6 to 72 months (mean 41 months). Functional assessment was carried out by the criteria delineated previously by Karkson, in which Grade A was in 24 cases, Grade B in 4cases, and C in 2. Conclusions: This modified technique, having less postoperative complications and less injuries to tissues and according well with the requirement of biomechanics, can achieve a stable reduction of acromioclavicular joint with a good functional and cosmetic result and therefore is preferable to use clinically on a large scale.展开更多
目的比较TightRope带襻钢板与Endobutton钢板在治疗肩锁关节脱位中的疗效。方法回顾性分析2021年3月~2023年2月常州市第二人民医院创伤中心94例肩锁关节脱位的临床资料,根据时间段分为2组,2021年3月~2022年2月采用Endobutton钢板治疗(E...目的比较TightRope带襻钢板与Endobutton钢板在治疗肩锁关节脱位中的疗效。方法回顾性分析2021年3月~2023年2月常州市第二人民医院创伤中心94例肩锁关节脱位的临床资料,根据时间段分为2组,2021年3月~2022年2月采用Endobutton钢板治疗(E组,n=47),2022年3月~2023年2月采用TightRope带襻钢板治疗(T组,n=47),末次随访比较2组围术期指标、疼痛视觉模拟评分(Visual Analogue Scale,VAS)、Constant-Murley肩关节功能评分及手术并发症发生率。结果T组手术时间、术中出血量、切口长度及术后7 d VAS评分明显短于/低于E组(P<0.05)。2组神经损伤、内固定移位、锁骨骨折、血管损伤及感染发生率无统计差异(χ~2=1.389,P=0.239)。2组术后9个月肩关节功能主客观评分与术前比较均得到明显改善(均P=0.000);术后9个月肩关节功能主客观评分2组比较差异无显著性(P>0.05)。结论TightRope带襻钢板和Endobutton钢板治疗肩锁关节脱位均效果显著,可有效改善患者肩关节功能。与Endobutton钢板比较,TightRope带襻钢板手术创伤更小,出血更少,明显减轻术后疼痛,更有利于患者早期功能锻炼。展开更多
目的:探讨三维可变翻转角快速自旋回波(sampling perfection with application optimized contrast using different flip angle evolution,SPACE)序列联合压缩感知(compressed sensing,CS)技术在肩锁关节损伤诊断中的应用价值。方法:...目的:探讨三维可变翻转角快速自旋回波(sampling perfection with application optimized contrast using different flip angle evolution,SPACE)序列联合压缩感知(compressed sensing,CS)技术在肩锁关节损伤诊断中的应用价值。方法:前瞻性地纳入2023年5月—2024年2月在南京医科大学第一附属医院就诊的有肩部外伤史、临床怀疑肩锁关节损伤的患者34例,对患者分别进行常规二维(two-dimension,2D)磁共振序列和基于CS的3D CS-SPACE序列扫描。分别在两组图像上测量肱二头肌长头腱和肱骨骨髓腔的信号强度和标准差,并计算出信噪比(signal to noise ratio,SNR)、对比噪声比(contrast to noise ratio,CNR);3位医生分别通过两组图像评估肩锁关节的损伤情况并给出其诊断信心评级。比较两组图像骨髓腔、肱二头肌长头腱的SNR、CNR以及诊断信心评级;分别分析3位医生在常规2D图像中的诊断一致性和3D CS-SPACE图像中的诊断一致性,最后评估两组图像之间的诊断一致性。结果:图像质量的客观评价中,3D CS-SPACE图像的SNR和CNR均明显优于常规2D图像;两组图像诊断信心的评级,2位医生的3D CS-SPACE图像评级明显高于常规2D图像,1位医生评级差异无统计学意义;3位医生在常规2D图像和3D CS-SPACE图像上对肩锁关节损伤的评估均具有较高的一致性(κ均>0.6),两组图像对肩锁关节的损伤评估具有较高的一致性(κ均>0.6)。结论:对于肩锁关节损伤的诊断,3D CS-SPACE图像与常规2D图像具有较高的一致性,且3D CS-SPACE序列能够在缩短扫描时间的同时获得更好的图像质量。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
文摘BACKGROUND Acromioclavicular joint(ACJ)space narrowing has been considered to be an important diagnostic image parameter of ACJ osteoarthritis(ACJO).However,the morphology of the ACJ space is irregular because of osteophyte formation,subchondral irregularity,capsular distention,sclerosis,and erosion.Therefore,we created the ACJ cross-sectional area(ACJCSA)as a new diagnostic image parameter to assess the irregular morphologic changes of the ACJ.AIM To hypothesize that the ACJCSA is a new diagnostic image parameter for ACJO.METHODS ACJ samples were obtained from 35 patients with ACJO and 30 healthy individuals who underwent shoulder magnetic resonance(S-MR)imaging that revealed no evidence of ACJO.Oblique coronal,T2-weighted,fat-suppressed SMR images were acquired at the ACJ level from the two groups.We measured the ACJCSA and the ACJ space width(ACJSW)at the ACJ on the S-MR images using our imaging analysis program.The ACJCSA was measured as the cross-sectional area of the ACJ.The ACJSW was measured as the narrowest point between the acromion and the clavicle.RESULTS The average ACJCSA was 39.88±10.60 mm;in the normal group and 18.80±5.13 mm;in the ACJO group.The mean ACJSW was 3.51±0.58 mm in the normal group and 2.02±0.48 mm in the ACJO group.ACJO individuals had significantly lower ACJCSA and ACJSW than the healthy individuals.Receiver operating characteristic curve analyses demonstrated that the most suitable ACJCSA cutoff score was 26.14 mm^(2),with 91.4%sensitivity and 90.0%specificity.CONCLUSION The optimal ACJSW cutoff score was 2.37 mm,with 88.6%sensitivity and 96.7%specificity.Even though both the ACJCSA and ACJSW were significantly associated with ACJO,the ACJCSA was a more sensitive diagnostic image parameter.
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.
基金Supported by the Scientific Fund of the Far Eastern Federal University(13-06-0318-m_a)
文摘Objective: To propose an original method of surgical treatment for the acromial extremity of the clavicle rupture(Rockwood II-VI) with modeled Kirschner wire and cortical screw. Methods: Anatomical study and a test method were applied to 43 cadavers of both sexes. During the period between 2000 and 2013, 34 patients of both sexes were operated upon using the new method. In the comparison group(n = 120), the fixation of the acromial extremity of the clavicle rupture was performed with hamate plate, Lee hook and Kirschner wires.Results: Its application allows, according to the evaluation scale of Constant and Murley(1987), 10% more preservation of the function of the shoulder compared with traditional methods of surgical treatment, and shortens the required hospital treatment and temporary disability periods.Conclusions: It is shown that the proposed author's method combines low invasiveness, minimum dimensions of the construction and low-cost treatment.
文摘Purpose: Acromioclavicular (AC) joint dislocation is commonly treated using a clavicle hook plate (HP). However, previous reports have indicated that acromial fractures may occur after HP fixation. The purpose of this study was to identify risk factors for acromial fractures. Methods: A retrospective study was conducted on 39 patients with AC joint dislocation who were treated using clavicle HP fixation in our hospital between 2006 and 2017. Related parameters, including Rockwood classification, hook angle, the degree of reduction, the coverage of the hook under the acromion, and the anteroposterior position of the hook under the acromion, were evaluated to identify risk factors for acromial fractures. Results: The mean age of the participants was 51.7 (range 19 - 81) years;34 were men and 5 were women. Injury occurred on the right side in 18 patients and on the left side in 21. Injuries were categorized as follows: 24 were Rockwood type III, one was type IV, and 14 were type V. Four of the 39 patients (10%) experienced acromial fractures. Statistical analyses indicated that the degree of reduction at the final follow-up was moderately correlated with the Constant score. Posterior positioning of the hook was the only identified risk factor for acromial fractures. Hook angle and the degree of reduction at the time of surgery were not significantly associated with acromial fractures. Conclusions: Postoperative shoulder function was associated with the degree of reduction at the final follow-up, suggesting that anatomical reduction is recommended for AC joint dislocation. Posterior positioning of the hook is a risk factor for acromial fractures;however, clavicle HP fixation provides a positive outcome for AC joint dislocation. Therefore, careful positioning of the hook is required for preventing acromial fractures.
文摘Introduction: The acromioclavicular joint is a superficial diarthrodial joint that surrounds the medial articular facet of the acromion and the distal portion of the clavicle. Due to its anatomy and biomechanics, it is highly susceptible to trauma and in young men who play contact sports, acromioclavicular dislocation is common. This article aimed to systematically review the literature and compare the surgical techniques used in the treatment of acromioclavicular dislocation in patients who practice sports. Methods: This systematic review was conducted according to the International Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Eligible studies for this systematic review included articles in English or Spanish published between 2013 and 2023, which mention the occurrence of acromioclavicular dislocation during sports practices. Additionally, only studies that addressed the surgical treatment of acromion-clavicular dislocation and contained original data on the topic were included. Results: We found 144 eligible studies after searching the LILACS and PubMed databases. Based on the inclusion and exclusion criteria and the reviewers’ consensus, we selected four studies for the systematic review. 133 patients with AC joint displacement were evaluated. Mean Age: approximately 31.90 years. 81.92 of these injuries occurred during sports practice. Surgical Procedures Used: titanium plates fixation (49 patients), arthroscopy (24), single tunnel technique (30) and coracoid sling technique (30). The results of the visual analog scale and Constant-Murley scores varied between the techniques used. Twenty-two complications after surgical treatment were identified. Conclusion: A significant variability of operative techniques can be used in the surgical approach of acromioclavicular dislocation, such as arthroscopy, single tunnel, coracoid sling and titanium plates. Although it presented excellent functional results compared to the other three techniques evaluated by this review, using titanium plates is not the gold standard since other techniques not assessed by this work may be more effective.
文摘Objective:To comparatively study complete dislo cation of acromioclavicular joint treated with three different methods. Methods:A total of 96 patients (81 males and 15 females, aged 16-59 years, mean=45 years) with complete dislocation of acromioclavicular join t were treated with Dewars operation (Group A, n=32), internal fixation with K irschner tension band wires (Group B, n=44), or internal fixation with Wolter pl ates (Group C, n=20), respectively, in this study. Eighty-five patients suffere d from acute dislocations and eleven from chronic dislocations. Results:The patients were followed up for 50 months on an aver age. According to Karlssons standard, in Group A, 26 patients were assessed as good, 5 as fair and 1 as poor. In Group B, 20 patients were assessed as good, 1 3 as fair and 11 as poor. In Group C, 15 patients were assessed as good, 4 as fa ir and 1 as poor. The good and fair rates were significantly different between G roup A and Group B, and between Group C and Group B, but no statistical differen ce was found between Group A and Group C. The operating time was ( 52.36 ± 7 .24 ) minutes, ( 67.43 ± 8.11 ) minutes and ( 69.73 ± 8.04 ) minutes in Groups A, B and C, respectively. And the hospitalizing fees were ( 2 400 ± 270) yuan, ( 2 100 ±190) yuan and ( 8 450 ±360) yuan in Groups A, B and C, respectively. Conclusions:Dewars operation is a good and safe method with shorter operating time and lower hospitalizing fee for treating complete disloca tion of acromioclavicular joint. The method is simple without the need of a seco nd operation to remove the implants and with few complications.
文摘Objective：To evaluate clinical outcome of suture anchors in strengthening both acromioclavicular and coracoclavicular ligaments in the surgical treatment of acromioclavicular joint dislocation.Methods：Twenty-eight patients with acute traumatic Rockwood Ⅲ,Ⅳ and Ⅴ dislocations of the acromioclavicular joint surgically treated at our institute between October 2010 and January 2012 were recruited.All patients underwent open reduction combined with suture anchors.Function was evaluated using the ConstantMurley shoulder score.Clinical and radiographic shoulder ratings were evaluated using Taft criteria at 3,6 and 12 months.Results：Two cases with fixation loosening were not included in final statistical analysis.Other patients obtained full joint reposition on immediate postoperative radiographs.Follow-up was performed with an average of 15.6 months （range,12-19）.After early range of motion exercises,96.2％ of the patients （25/26） could abduct and elevate their shoulders more than 90 degrees within postoperative 3 months.There was no infection.Average Constant-Murley score was 96.3 points （range,94-100）and mean Taft shoulder rating was 10.7 points （range,8-12） at 12 months.Conclusion：The suture anchor is a relatively simple technique and can avoid screw removal which is helpful in reconstructing both acromioclavicular and coracoclavicular ligaments in acute traumatic acromioclavicular joint dislocation.
文摘Objective: To report a new method of coracoid transposition for the treatment of complete dislocation of acromioclavicular joint and to evaluate its efficacy. Methods: We modified Dewar’s surgical method as follows: (1) Two small incisions, a transversal incision on the acromioclavicular joint and a longitudinal incision on the coracoid, were made instead of a conventional large arc incision from the acromion to coracoid. (2) The foreign body in the acromioclavicular joint was cleared out. The chondral surface at the lateral segment of clavicle was resected to form a pseudarthrosis and meanwhile the residual joint capsule and ligaments were repaired. (3) The coracoid was moved to the anteroinferior edge of the clavicle instead of the anterior margin and (4) the coracoid was moved to the lateral border of the clavicle instead of the superior border of the coracoclavicular ligament. Results: The follow up duration in 30 patients of the series was from 6 to 72 months (mean 41 months). Functional assessment was carried out by the criteria delineated previously by Karkson, in which Grade A was in 24 cases, Grade B in 4cases, and C in 2. Conclusions: This modified technique, having less postoperative complications and less injuries to tissues and according well with the requirement of biomechanics, can achieve a stable reduction of acromioclavicular joint with a good functional and cosmetic result and therefore is preferable to use clinically on a large scale.
文摘目的比较TightRope带襻钢板与Endobutton钢板在治疗肩锁关节脱位中的疗效。方法回顾性分析2021年3月~2023年2月常州市第二人民医院创伤中心94例肩锁关节脱位的临床资料,根据时间段分为2组,2021年3月~2022年2月采用Endobutton钢板治疗(E组,n=47),2022年3月~2023年2月采用TightRope带襻钢板治疗(T组,n=47),末次随访比较2组围术期指标、疼痛视觉模拟评分(Visual Analogue Scale,VAS)、Constant-Murley肩关节功能评分及手术并发症发生率。结果T组手术时间、术中出血量、切口长度及术后7 d VAS评分明显短于/低于E组(P<0.05)。2组神经损伤、内固定移位、锁骨骨折、血管损伤及感染发生率无统计差异(χ~2=1.389,P=0.239)。2组术后9个月肩关节功能主客观评分与术前比较均得到明显改善(均P=0.000);术后9个月肩关节功能主客观评分2组比较差异无显著性(P>0.05)。结论TightRope带襻钢板和Endobutton钢板治疗肩锁关节脱位均效果显著,可有效改善患者肩关节功能。与Endobutton钢板比较,TightRope带襻钢板手术创伤更小,出血更少,明显减轻术后疼痛,更有利于患者早期功能锻炼。
文摘目的:探讨三维可变翻转角快速自旋回波(sampling perfection with application optimized contrast using different flip angle evolution,SPACE)序列联合压缩感知(compressed sensing,CS)技术在肩锁关节损伤诊断中的应用价值。方法:前瞻性地纳入2023年5月—2024年2月在南京医科大学第一附属医院就诊的有肩部外伤史、临床怀疑肩锁关节损伤的患者34例,对患者分别进行常规二维(two-dimension,2D)磁共振序列和基于CS的3D CS-SPACE序列扫描。分别在两组图像上测量肱二头肌长头腱和肱骨骨髓腔的信号强度和标准差,并计算出信噪比(signal to noise ratio,SNR)、对比噪声比(contrast to noise ratio,CNR);3位医生分别通过两组图像评估肩锁关节的损伤情况并给出其诊断信心评级。比较两组图像骨髓腔、肱二头肌长头腱的SNR、CNR以及诊断信心评级;分别分析3位医生在常规2D图像中的诊断一致性和3D CS-SPACE图像中的诊断一致性,最后评估两组图像之间的诊断一致性。结果:图像质量的客观评价中,3D CS-SPACE图像的SNR和CNR均明显优于常规2D图像;两组图像诊断信心的评级,2位医生的3D CS-SPACE图像评级明显高于常规2D图像,1位医生评级差异无统计学意义;3位医生在常规2D图像和3D CS-SPACE图像上对肩锁关节损伤的评估均具有较高的一致性(κ均>0.6),两组图像对肩锁关节的损伤评估具有较高的一致性(κ均>0.6)。结论:对于肩锁关节损伤的诊断,3D CS-SPACE图像与常规2D图像具有较高的一致性,且3D CS-SPACE序列能够在缩短扫描时间的同时获得更好的图像质量。
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。
