| Background:With the rapid development of the modern transportation and industry, high-energy injury has showed a rising trend, leading to increasing incidence of shoulder injury. Acromioclavicular joint dislocation is a common form of the shoulder injury, accounting for about12%of the total amount. Compared to the past, not only does the incidence of the shoulder injury increase, so does the severity of it aggravate. With improvement of the welfare of the whole society, the expectation for a better treatment also rises. Under this circumstance, it is imperative to explore deep to the cause of the acromioclavicular joint dislocation, seek a better therapeutic strategy the circumvent the drawbacks of the past therapeutic methods, to the largest extent rehabilitating the patents for them to be able to return to work. The acromioclavicular joint dislocation is divided to three patterns in clinic:Tossy Ⅰ, Ⅱ, Ⅲ. In terms of acute Tossy Ⅰ and Ⅱ dislocation, the recognized therapeutic methods are conservative treatment, including the suspended immobilization in the early stage and rehabilitative functional exercise in the later stage. When it comes to the treatment of acute Tossy III dislocation, it is recommended that surgical approaches are adopted in the early stage to alleviate the symptoms and improve the function. Currently, there are a lot of surgical approaches available in addressing Tossy III dislocation, which can be roughly divided to seven types: simple internal fixation of the joint, simple reconstruction of the joint, dynamic muscle transfer, excision of the distal end of the clavicle, arthroscopic approach, combination of internal fixation and ligament reconstruction and combination of internal fixation and arthrodesis. Previous investigation of the treatment of Tossy III dislocation focuses on the comparison of the outcomes of various methods, while few considerations have been given to the cost, the trauma brought the surgery as well the complexity of each surgical procedure. But in our daily clinical practice, all of the abovementioned considerations should not be neglected. Especially to overcome the common complication after operation. Hence, by retrospective analysis of the commonly-used surgical approaches in clinics and referring to the mechanical mechanism reported underlying the injury and recovery of the shoulder joint, we modified a relatively novel surgical approach—acromioclavicular joint arthrodesis, devising a new surgical approach:combination of simple steel wire internal fixation and joint arthrodesis for clinical application. By comparing the new method with the previous commonly used methods, we attempt to find an approach that is relatively simple in procedure, low in medical expense, Fewer complications and satisfying in post-surgical outcomes. Objective:To explore a new effective and simple approach for surgical treatment of the acromioclavicular joint dislocation. The acromioclavicular joint arthrodesis is a relatively novel concept and surgical approach. We attempted to combine a new internal fixation method, the double-row parallel steel wire binding fixation, with the acromioclavicular joint arthrodesis, creating a new surgical approach:combination of the internal wire fixation with the acromioclavicular joint arthrodesis for clinical application. Comparison of the therapeutic outcomes of this new approach with other commonly-used approaches was made.MethodsFrom January,2003to December,2010, a total number of61patients with acromioclavicular joint dislocation were treated in our department, among them,26cases were treated with combination of the internal wire fixation with the acromioclavicular joint arthrodesis,7cases with Kirschner wire and tension band fixation,13cases with combination of Kirschner wire fixation and ligament reconstruction,15cases with clavicular hook and plate internal fixation. The former33cases were defined as the arthrodesis group, and the latter28cases were difined as the non-arthrodesis group. By the Karlsson standard, the therapeutic outcomes were assessed using parameters as follows:post-operative joint pain, motion range of the shoulder joint, myodynamia of the upper limbs, and x-ray image manifestation, and were classified into the following three grades:excellent, good and bad. Ratio of outcomes of patients as excellent, good and bad in the arthrodesis group and the non-arthrodesis group was calculated. Make the result into a statistical inference with the rank sum test.Outcomes:Outcome1:32cases of the33cases in arthrodesis group were followed up, and26cases of the28cases in non-arthrodesis group were followed up. Recovery of Acramioclavicular joint function in28cases were excellent, while in other3cases functions are normal except that there were limitation of up-lifting of the arm to90degree and loosening of Kirschner wire in1case. In the non-arthrodesis group, secondary dislocation and mild joint pain occurred in5and4cases, respectively.With95.08%patients being followed up, the results of the evaluation of the therapeutic outcomes using Karlsson standard were as follows:87.5%,9.38%, and3.12%of the outcomes of the patients in arthrodesis group were rated as excellent, good and bad, respectively, with the combination of excellent and good rates as96.88%.65.4%,15.4%and19.2%. the outcomes of the patients in non-arthrodesis group were rated as excellent, good and bad, respectively, with the combination excellent and good rats as80.8%. There are statistical differences in efficacy in the fusion group and the non-fusion group (Z=-2.093, P=0.036). The fusion group is effective than the non-fusion group.Outcome2:26cases were treated by the using of the double-row parallel steel wire binding fixation with the acromioclavicular joint arthrodesis for treatment of acromioclavicular dislocation.24of the26cases treated with combination of the internal wire fixation with the acromioclavicular joint arthrodesis were followed up ranging from6months to2years, among them the functional recovery of the acromicoclavicular joint in21cases were excellent, while in2other cases, joint functions were normal except that slight limitation of arm up-lifting to90degree occurred.1case felt pain obvioously.By Karlsson standard,87.5%,8.33%and4.17%of the outcomes of the patients treated by combination of the internal wire fixation with the acromioclavicular joint arthrodesis were rated as excellent, good and bad. respectively.Conclusions:Conclusion1Treatment of acromioclavicular joint dislocation using immobilization and arthrodesis of the acromioclavicular joint is simple in procedure, small in trauma and satisfying in outcome. The arthrodesis of the acromioclavicular joint has no obvious impact on the function of the shoulder joint, since the original function of the acromioclavicular joint is compensated by the function of the sternoclavicular joint and the rotation of the scapular bone. Compared to the non-arthrodesis method, it has the following merits:it is simple in procedure, low in recurrence rate, minor in primary and secondary surgeries, convenient in post-operative nursing and minor in functional impact on the shoulder joint. This approach is suitable for Tossy III acromioclavicular joint dislocation, particularly for the dislocation accompanied by severe articular structural injury, repeating and chronic dislocation, and dislocation in senile patients.Conclusion2Combination of the double-row parallel steel wire binding fixation with the acromioclavicular joint arthrodesis for treatment of acromioclavicular dislocation is simple in procedure, satisfying in outcomes, high in excellent and good rate, low in recurrence rat, negligible impact on postoperative joint function. This approach is modified from the existing methods of internal fixation and arthrodesis, which reduces the postoperative complications and conforms to biomechanics of the acromioclavicular joint. It needs to be emphasized that arthrodesis should used with caution in patients who held jobs that are demanding for the function of the shoulder joint, such as gymnastics, acrobatics and martial arts。... |
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