切换至 "中华医学电子期刊资源库"

中华肩肘外科电子杂志 ›› 2023, Vol. 11 ›› Issue (01) : 77 -82. doi: 10.3877/cma.j.issn.2095-5790.2023.01.013

综述

肩锁关节脱位的治疗进展
张涛1, 崔进1, 周启荣1, 陈晓1, 苏佳灿1,()   
  1. 1. 200433 上海,海军军医大学第一附属医院长海医院创伤骨科
  • 收稿日期:2022-09-15 出版日期:2023-02-05
  • 通信作者: 苏佳灿

Progress in the treatment of acromioclavicular joint dislocation

Tao Zhang1, Jin Cui1, Qirong Zhou1   

  • Received:2022-09-15 Published:2023-02-05
引用本文:

张涛, 崔进, 周启荣, 陈晓, 苏佳灿. 肩锁关节脱位的治疗进展[J]. 中华肩肘外科电子杂志, 2023, 11(01): 77-82.

Tao Zhang, Jin Cui, Qirong Zhou. Progress in the treatment of acromioclavicular joint dislocation[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2023, 11(01): 77-82.

肩锁关节脱位是肩部常见损伤之一,主要表现为患肩疼痛、肿胀和功能受限,严重影响患者的生活质量。目前,肩锁关节脱位的治疗方法主要包括保守治疗及手术治疗,每种治疗方式各有利弊。因此,对肩锁关节脱位各种治疗方法的研究,将有助于选择适合患者的治疗方式,达到最佳的治疗效果。该文主要对肩锁关节脱位的各种治疗方式及其治疗效果的对比进行综述。

表1 肩锁关节脱位的3种分型方式
表2 不同手术方式的对比
表3 肩锁关节脱位不同手术方式疗效研究
作者 研究方式 手术方式 样本量 术后评估 并发症 结论
Yoon等[22] 病例系列研究 钩钢板 24 VAS评分:(1.6±1.5)分 肩锁关节再脱位:0例;肩峰骨溶解:9例 VAS、CMS评分差异无统计学意义,但钩钢板组复发率更低
CMS评分:(90.2±9.9)分
人工韧带重建喙锁韧带 18 VAS评分:(1.3±1.3)分 肩锁关节再脱位:6例
CMS评分:(89.2±3.5)分
Li等[38] 回顾性研究 关节镜辅助喙锁韧带重建 32 ASES评分:(96±5.1)分 WeaverDunn组术后复发率更高 ASES、UCLA评分差异无统计学意义,关节镜组术后复发率低
UCLA评分:(96±5.1)分
改良WeaverDunn 31 ASES评分:94.5分
UCLA评分:(33.7±1.4)分
Metzlaff等[39] 回顾性研究 微创下肩锁韧带重建 44 CMS、ACJI评分:差异无统计学意义 异位骨化:11例 CMS、ACJI评分:两组无明显差异
钩钢板 44 异位骨化:8例
Kocaoglu等[37] 回顾性研究 自体肌腱移植重建喙锁韧带 16 ASES、CMS评分:韧带重建组更佳 术后再脱位率:WeaverDunn更高 ASES、CMS评分:韧带重建组更佳,改良WeaverDunn复位丢失率更高
改良WeaverDunn 16
Wang等[40] 病例系列研究 人工韧带重建喙锁及肩锁韧带 8 CMS评分:94.4分 未记录 CMS、UCLA评分:两组无明显差异
UCLA评分:33.5分
钩钢板 8 CMS评分:93.8分
UCLA评分:34.1分
Chang等[23] 治疗性研究 钩钢板 26 VAS评分:(4.5±2.3)分
UCLA评分:(19.9±4.9)分
肩峰骨溶解:钩钢板+喙锁韧带强化组较低 钩钢板+喙锁韧带强化组肩峰骨溶解率更低
ASES评分:(51.9±17.8)分
钩钢板+喙锁韧带加强 21 VAS评分:(2.3±1.4)分
UCLA评分:(27.2±4.0)分
ASES评分:(73.8±13.1)分
Stein等[28] 队列研究 钩钢板 27 Taft评分:(9.4±1.7)分 未记录 关节镜组术后肩关节评分更高,两组术后放射学未见明显差异
CMS评分:(90.2±7.8)分
关节镜辅助下双袢钢板 29 Taft评分:(10.9±1.1)分
CMS评分:(95.3±4.4)分
[1]
Liu S, Li C, Song Z. Comparison of open reduction and fixation with hook plate and modified closed reduction and fixation with tightrope loop plate for treatment of rockwood type III acromioclavicular joint dislocation[J]. BMC Musculoskelet Disord, 2022, 23(1):301.
[2]
Feichtinger X, Dahm F, Schallmayer D.Surgical versus conservative interventions for treating acromioclavicular dislocation of the shoulder in adults[J]. Knee Surg Sports Traumatol Arthrosc, 2021,8(3):2143-2151.
[3]
Rosso C, Martetschläger F, Saccomanno MF.High degree of consensus achieved regarding diagnosis and treatment of acromioclavicular joint instability among ESA-ESSKA members[J]. Knee Surg Sports Traumatol Arthrosc, 2021, 29(7): 2325-2332.
[4]
Velasquez Garcia A, Mendez M, Abdo G. All-Arthroscopic Coracoacromial Ligament Transfer: The Modified Neviaser Procedure for Acromioclavicular Dislocations[J] .Arthrosc Tech, 2022,11(4): e687-e695.
[5]
Phadke A, Bakti N, Bawale R. Current concepts in management of ACJ injuries[J]. J Clin Orthop Trauma, 2019,10(3): 480-485.
[6]
Okereke I, Abdelfatah E.Surgical Management of Acute Rockwood Grade III Acromioclavicular Joint Dislocations: A Systematic Review[J]. Cureus,2022,14(9): e28657
[7]
Kani KK, Porrino JA, Mulcahy H.Surgical techniques for management of acromioclavicular joint separations: review and update for radiologists[J]. Skeletal Radiol, 2020, 49(8): 1195-1206.
[8]
Saraglis G, Chaudhari H, Sanjani SR.Early loss of radiographic reduction after acute acromioclavicular joint reconstruction: Comparison of open Double Endobutton fixation vs. Nottingham Surgilig[J]. SICOT-J, 2022, 8: 46.
[9]
Verstift DE, Kilsdonk ID, van Wier MF. Long-term Outcome After Nonoperative Treatment for Rockwood I and II Acromioclavicular Joint Injuries[J]. Am J Sports Med, 2021, 49(3): 757-763.
[10]
Feichtinger X, Dahm F, Schallmayer D. Surgery improves the clinical and radiological outcome in Rockwood type IV dislocations, whereas Rockwood type III dislocations benefit from conservative treatment[J]. Knee Surg Sports Traumatol Arthrosc, 2021, 29(7): 2143-2151.
[11]
Shen G, Sun S, Tang C. Comparison of the TightRope system versus hook plate in acute acromioclavicular joint dislocations: a retrospective analysis[J]. Sci Rep, 2021,11(1):11397.
[12]
Moatshe G, Bøe B, LaPrade RF.Editorial Commentary: Early Surgery and Restricted Rehabilitation Are Recommended for High-Grade Acromioclavicular Joint Dislocation[J]. Arthroscopy, 2020, 36(10): 2642-2644.
[13]
Peng L, Zheng Y, Chen S. Single tunnel technique versus coracoid sling technique for arthroscopic treatment of acute acromioclavicular joint dislocation[J]. Sci Rep, 2022, 12(1):4044.
[14]
Martetschläger F, Horan MP, Warth RJ.Complications After Anatomic Fixation and Reconstruction of the Coracoclavicular Ligaments[J]. Am J Sports Med, 2013, 41(12): 2896-2903.
[15]
Tiefenboeck TM, Popp D, Boesmueller S. Acromioclavicular joint dislocation treated with Bosworth screw and additional K-wiring: results after 7.8 years – still an adequate procedure?[J]. BMC Musculoskelet Dis, 2017, 18(1):339.
[16]
Lateur G, Boudissa M, Rubens-Duval B.Long-term outcomes of tension band wiring with a single K-wire in Rockwood type IV/V acute acromio-clavicular dislocations: 25 cases[J]. Orthop Traumatol Surg Res, 2016,102(5): 589-593.
[17]
Zheng J, Chen J, Chen L. A novel hybrid fixation (coracoclavicular screw supplemented with K-wire) for the treatment of acute acromioclavicular joint dislocation: A prospective study[J]. Int J Surg, 2018, 59: 61-66.
[18]
Darabos N, Vlahovic I, Gusic N. Is AC TightRope fixation better than Bosworth screw fixation for minimally invasive operative treatment of Rockwood III AC joint injury?[J]. Injury, 2015, 46: S113-S118.
[19]
Xu D, Luo P, Chen J. Outcomes of surgery for acromioclavicular joint dislocation using different angled hook plates: a prospective study[J]. Int Orthop, 2017, 41(12): 2605-2611.
[20]
Turgut MC, Semis HS, Yamak K. Evaluation of Patients with Acromioclavicular Joint Separation Treated Using the Clavicular Hook Plate[J]. Ortop Traumatol Rehabil, 2022, 24(2): 73-78.
[21]
Lin HY, Wong PK, Ho WP.Clavicular hook plate may induce subacromial shoulder impingement and rotator cuff lesion——dynamic sonographic evaluation[J]. J Orthop Surg Res, 2014, 9: 6.
[22]
Yoon JP, Lee BJ, Nam SJ. Comparison of results between hook plate fixation and ligament reconstruction for acute unstable acromioclavicular joint dislocation[J]. CiOS Clin Orthop Surg, 2015, 7(1):97-103.
[23]
Chang HM, Hong CK, Su WR.Comparison of clavicular hook plate with and without coracoclavicular suture fixation for acute acromioclavicular joint dislocation[J]. Acta Orthop Traumatol Turc,2019, 53(6):408-413.
[24]
Masionis P, Šatkauskas I, Mikelevičius V. Biomechanical evaluation of native acromioclavicular joint ligaments and two reconstruction techniques in the presence of the sternoclavicular joint: a cadaver study[J]. J Orthop Surg (Hong Kong), 2017, 25(3):1-5.
[25]
Zhang L, He AN, Jin YF.Novel Double Endobutton Technique Combined with Three-Dimensional Printing: A Biomechanical Study of Reconstruction in Acromioclavicular Joint Dislocation[J]. Orthop Surg, 2020,12(5): 1511-1519.
[26]
Torkaman A, Bagherifard A, Mokhatri T. Double-button Fixation System for Management of Acute Acromioclavicular Joint Dislocation[J]. Arch Bone Joint Surg, 2016, 4(1): 41-46.
[27]
Müller D, Reinig Y, Hoffmann R. Return to sport after acute acromioclavicular stabilization: a randomized control of double-suture-button system versus clavicular hook plate compared to uninjured shoulder sport athletes[J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(12): 3832-3847.
[28]
Stein T, Müller D, Blank M. Stabilization of acute high-grade acromioclavicular joint separation: A prospective assessment of the clavicular hook plate versus the double double-button suture procedure[J]. Am J Sports Med, 2018, 46(11): 2725-2734.
[29]
Verstift DE, Matthijs PS, Derek FP. Review of Weaver and Dunn on treatment of acromioclavicular injuries, especially complete acromioclavicular separation[J]. J ISAKOS, 2021,6(2): 116-119.
[30]
Gupta R, Sood M, Malhotra A. Functional Outcome of Modified Weaver Dunn Technique for Acromioclavicular Joint Dislocation[J]. Indian J Orthop, 2018, 52(4):418-422.
[31]
Galasso O, Tarducci L, De Benedetto M.Modified Weaver-Dunn Procedure for Type 3 Acromioclavicular Joint Dislocation Functional and Radiological Outcomes[J]. Orthop J Sports Med, 2020, 8(3): 2325967120905022.
[32]
Chang HM, Wang CH, Hsu KL. Does Weaver-Dunn procedure have a role in chronic acromioclavicular dislocations? A meta-analysis[J]. J Orthop Surg Res, 2022, 17(1): 95.
[33]
Beitzel K, Obopilwe E, Apostolakos J. Rotational and Translational Stability of Different Methods for Direct Acromioclavicular Ligament Repair in Anatomic Acromioclavicular Joint Reconstruction[J]. Am J Sports Med, 2014, 8(2):2141-2148.
[34]
Maziak N, Audige L, Hann C. Factors Predicting the Outcome After Arthroscopically Assisted Stabilization of Acute High-Grade Acromioclavicular Joint Dislocations[J]. Am J Sports Med, 2019, 47(11): 2670-2677.
[35]
Saccomanno MF, Marchi G, Mocini F. Anatomic reconstruction of the coracoclavicular and acromioclavicular ligaments with semitendinosus tendon graft for the treatment of chronic acromioclavicular joint dislocation provides good clinical and radiological results[J]. Knee Surg Sports Traumatol Arthrosc, 2021, 29(7): 2356-2363.
[36]
Lee YM, Yeo JD, Hwang ZO. Reconstruction of the coracoclavicular ligament with palmaris longus tendon and Mersilene tape for acromioclavicular dislocations[J]. BMC Musculoskelet Dis, 2022, 23(1):648.
[37]
Kocaoglu B, Ulku TK, Gereli A. Palmaris longus tendon graft versus modified Weaver-Dunn procedure via dynamic button system for acromioclavicular joint reconstruction in chronic cases[J]. J Shoulder Elbow Surg, 2015, 26(9):1546-1552.
[38]
Li FL, Jiang CY, Lu Y. Arthroscopic coracoclavicular ligament reconstruction versus open modified Weaver-Dunn procedure for acromioclavicular joint disloca-tions: Comparison of curative effect[J]. Beijing Da Xue Xue BaoYi Xue Ban, 2015, 47(2):253-257.
[39]
Metzlaff S, Rosslenbroich S, Forkel PH. Surgicaltreatment of acute acromioclavicular joint dislocations: Hook plate versus minimally invasive reconstruction[J]. Knee Surg Sports Traumatol Arthrosc, 2015, 24(6):1972-1978.
[40]
Wang G, Xie R, Mao T, et al. Treatment of ACdislocation by reconstructing CC and AC ligaments with allogenic tendons compared with hook plates[J]. J Orthop Surg Res ,2018, 13: 175.
[41]
Ulrich S, Sean S, Simon A. Biomechanical Consequences of Coracoclavicular Reconstruction Techniques on Clavicle Strength[J]. Orthop J Sports Med, 2014, 2(2): 2325967114S00065.
[42]
Rolla PR, Surace MF, Murena L. Arthroscopic treatment of acute acromioclavicular joint dislocation[J]. Arthroscopy, 2004, 20(6):662-668.
[1] 陈山林, 魏绮珮, 刘畅. 腕关节假体:路在何方?[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 469-475.
[2] 仇申强, 王增涛, 郝丽文, 陈超, 刘林峰, 张迪. 拇手指全形再造二期整形的效果观察[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 485-490.
[3] 张健, 刘小龙, 查天建, 姚俊杰, 王傑. 富含血小板血浆联合异种脱细胞真皮基质修复糖尿病足缺血性创面的临床效果[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 503-506.
[4] 朴广昊, 李屹洲, 刘瑞, 赵建民, 王凌峰. 皮肤撕脱伤撕脱皮瓣活力早期评估与修复的研究进展[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 528-532.
[5] 张熙浩, 陈作观, 李拥军. 钝性主动脉损伤诊治的研究进展[J]. 中华损伤与修复杂志(电子版), 2023, 18(05): 438-441.
[6] 李芸, 乔栒柏, 邓华颉, 游云华. 增材制造Ti-6Al-4V钛合金种植体在牙缺失种植修复中的临床应用[J]. 中华口腔医学研究杂志(电子版), 2023, 17(05): 359-364.
[7] 叶长缨, 谢静, 丁桂聪. 乳牙龋病的过渡性治疗研究进展[J]. 中华口腔医学研究杂志(电子版), 2023, 17(05): 365-370.
[8] 李秋兰, 李希庭, 王晓东. 数字化技术引导下的美学修复一例[J]. 中华口腔医学研究杂志(电子版), 2023, 17(04): 260-264.
[9] 蓝凯文, 孙玥, 江柳霖, 阎英. 口腔修复临床诊疗中口颌系统功能评估的数字化实现[J]. 中华口腔医学研究杂志(电子版), 2023, 17(04): 265-271.
[10] 王得晨, 杨康, 杨自杰, 归明彬, 屈莲平, 张小凤, 高峰. 结直肠癌微卫星稳定状态和程序性死亡、吲哚胺2,3-双加氧酶关系的研究进展[J]. 中华普通外科学文献(电子版), 2023, 17(06): 462-465.
[11] 王博, 郭利君, 李二强, 张贺林, 徐鹏, 杨晓春. 消化道与口腔黏膜组织在输尿管重建中的研究进展[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 434-439.
[12] 钟文文, 李科, 刘碧好, 蔡炳, 脱颖, 叶雷, 马波, 瞿虎, 汪中扬, 王德娟, 邱剑光. 不同比例聚乳酸/丝素蛋白复合支架在兔尿道缺损修复中的疗效[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 516-522.
[13] 刘卓, 段虎斌. 生物电相关疗法在神经损伤修复中的应用进展[J]. 中华神经创伤外科电子杂志, 2023, 09(05): 257-260.
[14] 王延召, 牛鹏飞, 丁长民, 高庆坤, 高兆亚, 安柯, 翟志超, 曾庆敏, 黄文生, 雷福明, 顾晋. 结直肠癌致腹壁巨大缺损的一期修补经验(附13例报告)[J]. 中华临床医师杂志(电子版), 2023, 17(05): 557-561.
[15] 马四海, 杨剑, 马显武, 张敏, 吕明礼, 李启菊, 杨轶声, 刘海生. Shamblin Ⅱ型颈动脉体瘤的诊疗及文献综述[J]. 中华临床医师杂志(电子版), 2023, 17(04): 467-470.
阅读次数
全文


摘要