改良Weaver-Dunn法结合锁骨钩钢板内固定治疗TossyⅢ型肩锁关节脱位的病例对照研究

目的:对比锁骨钩钢板内固定术与改良Weaver-Dunn法联合锁骨钩钢板内固定术治疗TossyⅢ型肩锁关节脱位的临床疗效。方法:回顾性分析2012年1月至2014年1月手术治疗的41例新鲜TossyⅢ型肩锁关节脱位患者的临床资料,按其手术方式分为锁骨钩钢板内固定术(A组)和改良Weaver-Dunn法联合锁骨钩钢板内固定术(B组).A组21例,男15例,女6例,年龄17～51 岁,平均(31.60±12.58)岁,术前Constant-Murley评分40.25±9.80,采用锁骨钩钢板内固定术;B组20例,男13例,女7例,年龄18～48 岁,平均(29.40±11.27)岁,术前Constant-Murley评分41.45±8.81,采用改良Weaver-Dunn法联合锁骨钩钢板内固定术。比较两组患者的手术时间、术中出血量、手术前后影像学变化、术后并发症,分别于术后3、6、12个月时,采用Constant-Murley评分进行疗效评价。结果:A组手术时间(40.50±24.36) min,术中出血量(75.30±30.36) ml; B组手术时间(60.10±23.55) min,术中出血量(100.70±40.12) ml;A组21例获随访,时间12～18 个月,平均(14.8±3.1)个月; B组20例获随访,时间12～14 个月,平均(13.6±1.5)个月。两组手术时间、术中出血量比较差异有统计学意义。两组随访时间比较差异无统计学意义。术后A组6例出现并发症,B组3例,两组比较差异无统计学意义。术后6个月时,A组Constant-Murley评分为88.85±4.23,B组为92.15±3.82,两组比较差异有统计学意义(t=-2.56,P=0.022<0.05);其余各时间点比较差异无统计学意义。结论:锁骨钩钢板内固定术与改良Weaver-Dunn法联合锁骨钩钢板内固定术均是治疗TossyⅢ型肩锁关节脱位的有效手术方法。锁骨钩钢板内固定术较改良Weaver-Dunn法联合锁骨钩钢板内固定术创伤小,但改良Weaver-Dunn法联合锁骨钩钢板内固定术重建的喙锁韧带更牢固,且能早期取出锁骨钩钢板,可以更早地改善患者的肩关节功能。     

Managing and recognizing complications after treatment of acromioclavicular joint repair or reconstruction

Complications of the acromioclavicular joint injuries can occur as a result of the injury itself, conservative management, or surgical treatment. Fortunately, the majority of acromioclavicular surgeries utilizing modern techniques and instrumentation result in successful outcomes. However, clinical failures do occur with frequency. The ability to identify the causative factor of failures makes revision surgery more likely to be successful. The purposes of this review are to highlight common problems that can occur following acromioclavicular joint surgery and discuss techniques that can be utilized in revision surgery.     

Acromioclavicular Septic Arthritis and Sternoclavicular Septic Arthritis with Contiguous Pyomyositis

Acromioclavicular (AC) and sternoclavicular (SC) septic arthritis with contiguous pyomyositis are rare, especially in immunocompetent individuals. We report a case of septic AC joint with pyomyositis of the deltoid and supraspinatus muscles and a separate case with septic SC joint with pyomysitis of the sternocleidomastoid muscle. Both patients had similar presentations of infections with Staphylococcus aureus and were successfully treated with surgical incision and drainage followed by prolonged antibiotic therapy.     

RETRACTED: A new test for acromio-clavicolar pathology

Background

A prospective study was established to assess the sensitivity and specificity of the new Saccomanni (SAC) test for isolated AC pathology, and compare with 4 commonly used clinical tests.

Materials and methods

The Saccomanni (Sac) test is essentially the cross-adduction test, with the addition of attempted elevation against resistance. In a positive test, this results in some pain and the inability of the patient to maintain the arm in the adducted and elevated position against resistance. Fifty-eight patients with isolated AC joint symptoms were assessed in random order with the Saccomanni test and 4 other tests. A corticosteroid and local anaesthetic injection was administered into the AC joint space. The Saccomanni test and 4 other tests were then repeated following the injection. After the injection, a symptom free clinical examination was used as a measure of true positive tests.

Study design

Case series.

Results

The SAC test showed a sensitivity of 98% and specificity is 91.7%. All 4 other tests were less sensitive.

Conclusion

The SAC test is a highly sensitive test in patients presenting with isolated AC related symptoms.This study is an innovation for clinical tests in the world. The primary aim of this study was to assess the diagnostic sensitivity of my newly described SAC test. From the present study, it can be concluded that the easy-to use SAC is a highly sensitive test to evaluate AC joint pathology, when compared to other standard tests.

Clinical relevance

Level III, Diagnostic Study of Nonconsecutive Patients.     

Surgical Treatment of Fresh Complete Acromioclavicular Dislocation by Coracoid Process Transfer and K-Wire Transfixation

Acromioclavicular dislocations are very common shoulder injuries. The optimal treatment for acute high-grade acromioclavicular joint injury remains a matter of debate. The purpose of this study was to evaluate the results of surgical treatment of complete acromioclavicular dislocation using coracoid process transfer and temporary K-wire transfixation. Twenty-one patients with complete acromioclavicular dislocation underwent coracoid process transfer and temporary K-wire transfixation. Patients were assessed at the follow-up based on visual analog scores (VAS), the Constant–Murley scoring system and the UCLA shoulder rating system. Radiographs were taken to check up vertical instability. The mean follow-up was 32.1 months (25–47 months). The mean Constant and Murley score and UCLA shoulder rating score was 89.9 ± 8.4 and 30.1 ± 4.4. There were fourteen excellent functional results and six results and one poor result. The overall rate of satisfaction, which means an excellent or good result, was 95.2 %. Nineteen patients (90.4 %) maintained their previous jobs or resume their daily activities. The mean final pain score, as measured from 1 to 10 on the visual analog scale, was 1.91 ± 1.09. The radiographic analysis revealed twenty patients had maintained reduction at the final follow-up. The coracoid process transfer and temporary K-wire transfixation is a reliable treatment for a complete acromioclavicular dislocation.     

双Endobutton技术与锁骨钩钢板治疗Tossy Ⅲ型肩锁关节脱位的疗效比较

目的 比较双Endobutton技术与锁骨钩钢板(CHP)治疗TossyⅢ型肩锁关节脱位的近期疗效. 方法 回顾性分析2009年3月至201 1年12月收治的59例TossyⅢ型肩锁关节脱位患者资料,男41例,女18例;年龄21 ～ 69岁,平均44.0岁;左侧21例,右侧38例.按治疗方式不同分为双Endobutton组(26例)和CHP组(33例).两组患者术前一般资料比较差异均无统计学意义(P＞0.05),具有可比性.术后随访观察并比较两组患者患肩疼痛视觉模拟评分(VAS)、外展上举及前屈上举活动度、Constant-Murley评分及Karlsson分级. 结果 所有患者术后获11 ～30个月(平均15.2个月)随访.术后9个月双Endobutton组与CHP组患者患肩VAS评分平均分别为(2.1±0.7)、(2.9±0.8)分;双Endobutton组患肩外展上举和前屈上举活动度平均分别为100.8°±13.2°、131.5°±13.3°,CHP组分别为81.3°±8.3°、96.6°±10.8°,两组患者以上观察指标比较差异均有统计学意义(P＜0.05);双Endobutton组和CHP组Constant-Murley评分平均分别为(85.3±6.3)、(82.4±6.1)分,Karlsson分级优良率分别为84.6％ (22/26) 、90.9％ (30/33),两组患者以上指标比较差异均无统计学意义(P＞0.05). 结论 双Endobutton技术与CHP治疗TossyⅢ型肩锁关节脱位的疗效相当,但前者较后者可更明显地改善患者早期肩关节疼痛、肩关节外展上举和前屈上举活动范围.     

双Endobutton钢板与锁骨钩钢板内固定治疗Rockwood Ⅲ～Ⅴ型肩锁关节脱位的疗效比较

目的比较双Endobutton钢板技术与锁骨钩钢板内固定治疗RockwoodⅢ~Ⅴ型肩锁关节脱位的中期疗效。方法回顾性分析自2009-06—2014-05分别采用双Endobutton钢板与锁骨钩钢板内固定治疗的40例RockwoodⅢ~Ⅴ型肩锁关节脱位。比较2组术后3个月、1年的患肩疼痛视觉模拟评分(VAS)、Constant肩关节功能评分。结果 40例术后均随访满1年。Endobutton钢板组手术时间长于锁骨钩钢板组,差异有统计学意义(P0.05)。术后3个月Endobutton钢板组的Constant评分及VAS评分均优于锁骨钩钢板组,差异有统计学意义(P0.05);但2组术后1年Constant评分及VAS评分比较差异无统计学意义(P0.05)。2组术后1年Constant评分及VAS评分均优于术后3个月,差异有统计学意义(P0.05)。术后1年Endobutton钢板组1例出现复位丢失,1例出现肩部疼痛;锁骨钩钢板组未出现复位丢失,但5例肩部疼痛。结论双Endobutton钢板内固定治疗RockwoodⅢ~Ⅴ型肩锁关节脱位的中期效果与锁骨钩钢板内固定并无明显差异,但Endobutton钢板内固定对肩关节功能影响小、术后肩痛发生率低、内固定不必取出。     

三重无袢Endobutton钢板联合Orthcord线治疗TossyⅢ型肩锁关节脱位

目的 :探讨采用三重无袢Endobutton钢板联合Orthcord线手术方法治疗TossyⅢ型肩锁关节脱位的临床疗效。方法:2011年2月至2013年9月,采用三重无袢Endobutton钢板联合Orthcord线方法治疗36例TossyⅢ型肩锁关节脱位患者,男21例,女15例;年龄9~48岁,平均(26.41±14.05)岁;病程2~7 d。临床表现为患肩肿痛,外展活动受限,肩锁关节处压痛,琴键征阳性。术后观察其临床症状及并发症,并采用肩锁关节脱位评分系统进行肩关节功能评价。结果:36例患者术后均获得随访,时间8~15个月,平均(12.2±4.3)个月,所有患者术后切口Ⅰ期愈合。末次随访时全部患侧肩部疼痛消退,肩锁关节处无压痛,琴键征阴性。术后无再次脱位、钢板松动等发生。根据肩锁关节脱位评分系统:优31例,良5例。结论:三重无袢Endobutton钢板联合Orthcord线技术治疗TossyⅢ型肩锁关节脱位时锁骨及喙突骨折风险更小,并发症少,功能恢复好,是理想的治疗方法。