Zusammenfassung
Hintergrund
Für die operative Versorgung von Akromioklavikular(AC-)gelenkverletzungen gibt es eine Vielzahl von Operationsmethoden. Neben teils schlechten Ergebnissen und hohen Komplikationsraten stellt die Invasivität mancher Operationen ein weiteres Problem dar. Deswegen wurde in unserer Abteilung ein neues minimal-invasives, arthroskopisch gestütztes Verfahren zur AC-Gelenkrekonstruktion entwickelt und in einer 1. Serie eine prospektive Studie zum Outcome nach Operation von Rockwood-IV- und -V-Verletzungen durchgeführt.
Methoden
Zielkriterien waren postoperative Schulterfunktion (Constant-Score), Patientenzufriedenheit bezüglich Funktion und Kosmetik, radiologisches Ergebnis, sowie Komplikationen der neuartigen Operationsmethode.
Ergebnisse
13 Patienten mit Rockwood-IV- oder -V-Verletzungen wurden in dieser 1. Serie operiert. Davon konnten 12 in die Studie eingeschlossen werden, es gab einen „drop out“. Nach einem durchschnittlichen Follow-up von 9 Monaten kam es zu folgenden Ergebnissen: durchschnittlicher Constant-Score=97; alle Patienten waren mit der Funktion und Kosmetik zufrieden oder sehr zufrieden; radiologisch kam es im Vergleich zur Gegenseite in 2 Fällen zu Subluxationen zwischen 2–4 mm im AC-Gelenk; bei den restlichen 10 Patienten konnte keine Dislokation oder eine maximale Dislokation von 2 mm festgestellt werden, was als anatomisch gewertet wurde. Intra- und perioperativ kam es zu keinen Komplikationen.
Schlussfolgerungen
Anhand der vorliegenden Ergebnisse denken wir, dass es sich um eine sichere Operationsmethode zur anatomischen Rekonstruktion bei AC-Gelenkverletzungen handelt. Weitere, vergleichende Studien mit größeren Kollektiven müssen allerdings folgen, um die Ergebnisse zu verifizieren.
Abstract
Background
Over 100 techniques for acromioclavicular joint (ACJ) reconstruction have been described. Most of these techniques are invasive and are associated with a high complication rate. We therefore developed a new minimally invasive arthroscopic technique for reconstruction of the ACJ.
Methods
The new operation technique is described in detail. We operated 13 patients with Rockwood IV or V dislocations of the ACJ using this new technique. Intra- and postoperative complications were recorded. Each patient was evaluated after 3, 6, and 9 months using the Constant score for shoulder function and radiographs (anteroposterior, axillary, and Zanca views) of the operated and nonoperated shoulder for radiologic evaluation. The objective of this study was to evaluate the first clinical results and complication rates using this technique.
Results
The mean follow-up was 9 months. Of the 13 patients, 12 could be included in the study and we had 1 dropout. The mean Constant score was 97; all patients were satisfied with the postoperative shoulder function and cosmetics. Radiologically we observed ten patients with anatomic reduction and two with a subluxation between 2 and 4 mm compared to the nonoperated side. In one patient we determined coracoclavicular ossifications which were asymptomatic. There were no complications intra- and postoperatively.
Conclusions
These first results suggest that this is a good and safe technique for ACJ reconstruction. Further randomized studies with more patients have to follow to confirm the results.
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Elser, F., Chernchujit, B., Ansah, P. et al. Eine neue minimal-invasive arthroskopische Technik zur Akromioklavikulargelenkrekonstruktion. Unfallchirurg 108, 645–649 (2005). https://doi.org/10.1007/s00113-005-0933-0
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DOI: https://doi.org/10.1007/s00113-005-0933-0