关键词: 肩锁关节, 肩脱位, 关节镜检查, 修复外科手术

Abstract: Objective：To compare the surgical outcomes between arthroscopic coracoclavicular ligament reconstruction and open modified Weaver-Dunn procedure for the treatment of acromioclavicular joint dislocations. Methods:From January 2011 to June 2012, 63 consecutive patients with acromioclavicular joint dislocations who were treated with either arthroscopic coracoclavicular ligament reconstruction or open modified Weaver-Dunn procedure were retrospectively reviewed after the final follow-up. There were 49 men and 14 women with a mean age of (40.3±10.6) years. The mean time from injury to surgery was (10.3±5.3) d. According to the Rockwood classification, there were 45 patients with type V injury and 18 patients with type Ⅲ injury. All the patients with type Ⅲ injury claimed high level of sport activity. The patients were divided into the arthroscopic surgery group (32 cases) or the open surgery group (31 cases) depending on the type of the surgery that each patient had taken. All the patients were routinely followed up after the surgery. The visual analogue score (VAS), American shoulder and elbow surgeons(ASES) score and University of California Los Angeles(UCLA) score were employed to evaluate the postoperative shoulder function. The postoperative radiographs of both shoulders were taken for each patient to evaluate the loss of reduction of the acromioclavicular joint.Results:The mean follow-up time was (29.6±6.0) months (range: 24 to 43 months). No significant difference was found between the arthroscopic surgery group and the open surgery group with regard to the patient’s age ［(41.0±10.5) years vs. (38.0±10.8) years］, gender (male/female，24/8 vs.25/6), classification (Ⅴ/Ⅲ，22/10 vs.23/8), time from injury to surgery ［(10.6±4.9) d vs.(10.1±5.7) d］, dominant involvement (19/32 vs.17/31)and mean follow-up time ［(29.8±6.4) months vs.(29.5±5.5) months］, P>0.05. At the end of the last followup, no significant difference was noted between the two groups regarding the mean forward elevation ［(164.4±17.2) degrees vs.(162.6±12.9) degrees］, mean external rotation ［(60.9±17.0) degrees vs.(57.3±15.8) degrees］, mean internal rotation ［(T12±3 vertebrae) vs.(T12±3 vertebrae)］, mean ASES scores (96.0±5.1 vs. 94.5±3.8)and UCLA scores (34.2±1.5 vs. 33.7±1.4), P>0.05.The rate of loss of reduction was significantly lower in the arthroscopic surgery group (1/32) compared with the open surgery group (7/31, P=0.026).Conclusion:Surgical treatment for acromioclavicular joint dislocations with either arthroscopic reconstruction or open modified Weaver-Dunn procedure could yield good results with no significant difference between the two groups as for the postoperative shoulder function. The rate of loss of reduction was lower in the arthroscopic surgery group compared with that of the open surgery group.

Key words: Acromioclavicular joint, Shoulder dislocations, Arthroscopy, Reconstructive surgical procedures