Resection of the acromial and sternal end of the clavicle

The causes of complaints in the acromioclavicular joint include arthrosis after dislocation of the joint, metastases, polyarthritis, tuberculosis, or hyperparathyroidism. Some causes have not yet been identified. If conservative therapy is unsuccessful the condition may be treated by resection of the acromial end of the clavicular, as first described by Gurd and Mumford. The present paper reports the results obtained in 22 patients who were followed up. Complete freedom from pain was achieved in 59% of the cases and improvement in 23.7%, while in 13.6% the results had to be classified as unchanged or poor. An analysis of these results admits the conclusion that with restricted indication and in particular in post-traumatic conditions, it is certainly possible to achieve results which make this technically simple procedure the treatment of choice in arthrosis of the acromioclavicular joint; this is borne out by the literature. In much rarer cases, changes in the sternoclavicular joint have to be surgically treated. Here also, the majority of cases are post-traumatic changes, and here again most of them are conditions following anterior luxation. Analogously to resection at the acromial end of the clavicula, a resection at its sternal end may also produce successful results. With reference to three of the authors' own cases, the clinical picture is considered and the results are presented and discussed; however, since the various surgical techniques cannot be compared, a final evaluation is only possible to a limited extent.     

肩锁关节脱位的锁骨钩钢板治疗

目的探讨肩锁关节脱位的锁骨钩钢板治疗方法 ,并评价其临床效果。方法应用锁骨钩钢板治疗肩锁关节完全脱位17例,采用臂丛麻醉,锁骨外侧段上方入路,修复肩锁韧带、喙锁韧带,锁骨钩钢板于锁骨上方固定。结果所有病例均获得随访,按Karlsson标准评定:优15例,良2例。结论锁骨钩钢板治疗肩锁关节脱位,方法简单,疗效可靠。     

线缆套绕喙突与锁骨固定治疗肩锁关节脱位的临床观察

目的：观察线缆套绕喙突与锁骨固定治疗新鲜单侧TossyⅢ型肩锁关节脱位的临床效果。方法回顾分析2007年12月至2016年3月于我院采用切开复位、线缆套绕喙突与锁骨固定治疗新鲜单侧TossyⅢ型肩锁关节脱位的39例病人的临床资料,通过其术后X线片评价其恢复情况,采用Karlsson疗效评价标准对患肩功能进行评定。结果本组病人随访时间为6~60个月,平均为16个月。术后肩关节外观及功能恢复满意,未见线缆断裂和松动的现象。按照Karlsson疗效评价标准对肩关节功能进行评定,其中优30例,良9例,优良率为100%。结论线缆套绕固定喙突与锁骨符合肩锁关节复位固定的生物力学要求,具有疗效好、创伤小、操作简单的优点,是治疗TossyⅢ型肩锁关节脱位的一种有效手术方法。     

Resection of the lateral end of the clavicle following osteolysis, with emphasis on non-traumatic osteolysis of the acromial end of the clavicle in athletes

Preoperative radiographs of 38 patients who had undergone resection of the lateral end of the clavicle were reviewed. Seven cases of osteolysis of the lateral end of the clavicle were found, of which four followed severe injury of the shoulder girdle. Three of the cases were young male athletes, with nontraumatic osteolysis. One additional patient with this disorder, in whom resection has not yet been performed, was also included. All four had practised weightlifting and benchpressing as part of their training. Hence, a feasible explanation for the osteolytic process seems to be repeated microfractures due to stresses imposed by these activities. Several conservative regimens provided only temporary relief. After resection, the symptoms ceased and the patients were able to return to competitive sport. With the increasing interest in bodybuilding, non-traumatic osteolysis of the acromial end of the clavicle should be borne in mind in cases of pain in the shoulder in athletes.     

锁骨钩钢板联合空心钉内固定治疗肩峰骨折合并肩锁关节脱位

目的探讨锁骨钩钢板联合空心钉内固定治疗肩峰骨折合并肩锁关节脱位的临床疗效。 方法回顾性分析本院骨科自2008年1月至2018年12月收治的15例肩峰骨折合并肩锁关节脱位患者的临床资料,其中男13例、女2例;患者年龄范围18 ~ 60岁,平均年龄（34.67±15.53）岁;致伤原因：交通伤8例,摔伤2例,坠落伤3例,运动伤2例。肩峰骨折分型,OgawaⅠ型5例,OgawaⅡ型10例;肩锁关节脱位分型,TossyⅡ型7例,TossyⅢ型8例。治疗方案均为肩峰骨折采用切开复位空心钉内固定治疗,肩锁关节脱位采用切开复位锁骨钩钢板内固定治疗。术后1年根据患者患侧肩关节活动范围及肩关节Constant-Murely评分对患者进行功能评价。 结果所有患者均获得至少1年以上随访,平均随访时间（21.60±9.83）个月,术后患者切口均一期愈合,未发生伤口感染、骨折愈合不良、骨折脱位复位丢失、肩峰下撞击、钢板螺钉松动等情况。术后1年肩关节活动范围：外展90° ~ 145°,平均（114.00±19.29）°;上举100°～180°,平均（136.67±27.10）°;后伸30° ~ 60°,平均（42.00±10.66）°;外旋30° ~ 45°,平均（38.00±6.76）°。术后1年Constant-Murely评分70 ~ 96分,平均（85.73±7.26）分,优5例,良7例,可3例,优良率80％。 结论锁骨钩钢板联合空心钉内固定治疗肩峰骨折合并肩锁关节脱位操作安全、简单、疗效确切,术后患者功能恢复满意,值得在临床中应用。     

Coplaning of the acromioclavicular joint

Purpose: Coplaning removes inferior spurs or portions of the distal clavicle to decrease injury to the rotator cuff. This study sought to determine if the presence or degree of coplaning influenced the results and if reoperations for distal clavicle symptoms were needed. Type of Study: Nonrandomized control study. Methods: A total of 76 patients undergoing arthroscopic subacromial decompression (ASD) followed for at least 25 months were divided into 3 groups. Group 1 included 28 patients who underwent ASD with removal of only an inferior clavicular osteophyte. Group 2 included 27 patients with resection of any inferior clavicle spur, violation of the inferior joint capsule, and removal of articular cartilage to a level adjacent with the resected acromion. As much as 50% of the articular cartilage was removed in some cases. Group 3 included 21 patients who underwent a complete distal clavicle excision. Radiographs, charts, and arthroscopic videotapes were reviewed and the degree of claviculectomy exactly determined. Follow-up evaluations included the Constant-Murley, American Shoulder and Elbow Surgeons (ASES), SANE, and Rowe shoulder scores, with special attention given to acromioclavicular (AC) joint pain and additional operations. Results: The average age of the patients was 49 years (range, 19 to 81 years) and follow-up averaged 40 months (range, 25 to 68 months). Follow-up Constant, ASES, Rowe, and SANE scores for the various groups were calculated. Group 1 scores were 99.4, 98.7, 98.6, and 98.1, respectively; group 2 scores were 96.8, 98.7, 98.5, and 95.7, respectively; and group 3 scores were 98.4, 99.4, 99.3, and 98.6, respectively. No patient required any additional AC joint surgery. Conclusions: Violation of the AC joint capsule and partial distal clavicle resection to make it confluent with the resected acromion (coplaning), does not cause increased AC joint symptoms, compromise the results, or lead to additional surgery at an average 40-month follow-up.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 9 (November-December), 2001: pp 913–917     

AO肩锁钩钢板治疗肩锁关节完全脱位临床疗效评价

目的 评价AO肩锁钩钢板治疗肩锁关节完全脱位的临床疗效。方法 本组43例，其中23例采用A0肩锁钩钢板、辅以肩锁韧带与喙锁韧带可吸收缝线修补术；20例采用克氏针内固定术。结果 根据术后X线片和关节功能恢复情况评定疗效，两者的疗效优良率分别为95．6％、65％，疗效差异有统计学显著性意义。结论 应用A0肩锁钩钢板、重建喙锁韧带和肩锁韧带治疗肩锁关节完全脱位疗效可靠。     

Treatment of dislocations of the acromial end of the clavicle

Based upon an analysis of observations of 93 patients treated for dislocation of the acromial end of the clavicle and a study of long-term results of the treatment of 68 of them, the authors recommend using the method of a one-step closed setting the acromial end of the clavicle followed by a percutaneous transarticular fixation of the clavicular-acromial junction with the Kirschner wire and plaster bandage for 6 weeks.     

Injuries to the acromioclavicular joint

Injuries to the acromioclavicular joint are common but underdiagnosed. Sprains and minor subluxations are best managed conservatively, but there is debate concerning the treatment of complete dislocations and the more complex combined injuries in which other elements of the shoulder girdle are damaged. Confusion has been caused by existing systems for classification of these injuries, the plethora of available operative techniques and the lack of well-designed clinical trials comparing alternative methods of management. Recent advances in arthroscopic surgery have produced an even greater variety of surgical options for which, as yet, there are no objective data on outcome of high quality. We review the current concepts of the treatment of these injuries.