Vergleich und Ergebnis von Schultereckgelenkverletzungen II. und III. Grades

Die funktionelle Untersuchung mittels des Score nach Constant und Murley ergab durchschnittlich 97 von 100 möglichen Punkten (Minimum 72, Maximum 100) in beiden Gruppen, sowohl nach konservativer als auch nach operativer Therapie. Bei der Nachuntersuchung wiesen 9 von 10 konservativ (90%) behandelten Patienten nach drittgradiger AC-Luxation ein positives Klaviertastenphänomen und eine vermehrte Horizontalverschieblichkeit der Klavikula im Gegensatz zu 18 (44%) von 41 operierten Patienten auf (p<0,0001). Allerdings wurde dadurch das funktionelle Ergebnis nicht beeinflußt. Weiters kam es in beiden Gruppen unabhängig vom Therapieverfahren zu einer deutlichen Zunahme der degenerativen radiologischen Veränderungen (p<0,035), aber ebenfalls ohne Einfluß auf das gute funktionelle Ergebnis. Die operierten Patienten wiesen dabei mehr radiologische Veränderungen auf als die nicht operierten Patienten (p<0,003). In Gruppe I waren die operierten Patienten öfter in der Sportausübung eingeschränkt, als die konservativ behandelten (p<0,05). Operierte Patienten in Gruppe II klagten häufiger über Schmerzen (p<0,01) und waren länger im Krankenstand (p<0,001) als die konservativ behandelte Vergleichsgruppe. Die Durchführung einer Physikotherapie hatte keinen Einfluß auf das funktionelle Ergebnis.

Bei 11 von 56 operativ behandelten Patienten kam es zu Komplikationen, welche bei 5 Patienten einen weiteren chirurgischen Eingriff notwendig machten. Von den 29 konservativ behandelten Patienten mußten bei 1 Patienten subakromial gelegene arthrotische Veränderungen des AC-Gelenks mittels subakromialer Dekompression entfernt werden.

Eighty-five patients with grade 2 or grade 3 sprains of the acromioclavicular (AC) joint were evaluated clinically and radiographically 32 months after injury. Group I included 34 patients with grade 2 sprains (Tossy II) and group II included 51 patients with grade 3 injuries (Tossy III). In group I, 15 patients were treated surgically (group I a) and 19 patients were treated conservatively (group I b), while in group II, 41 patients were treated surgically (group II a) and 10 patients were treated conservatively (group II b). At surgery open reduction and transarticular fixation of the AC joint with Kirschner wires was performed. Conservative treatment included the initial use of a sling or a knapsack bandage and early performance of range-of-motion exercises. Shoulder function was assessed according to the score devised by Constant and Murley. In both groups, 97 of 100 possible points (minimum 72, maximum 100) were obtained after conservative and after surgical treatment. Nine of 10 patients (90%) with grade 3 sprains (group IIb) had more pronounced displacement and increased mobility of the lateral end of the clavicle after conservating treatment. After surgery, dislocation and increased horizontal, mobility of the lateral end of the clavicle occurred in 18 (44%) of 41 patients with grade 3 sprains (group II a P<0.0001). However, these findings did not correlate with the functional outcome. At follow-up there was a significant increase in degenerative changes seen on radio-graphs (P<0.035) in all patients. Again these findings did not correlate with the functional outcome. More degenerative radiological changes were observed in patients who had undergone surgery (P<0.003). Patients with grade 2 sprains were more frequently restricted in sporting activity after surgery (P<0.05). Patients with grade 3 sprains who were treated surgically complained of pain more frequently (P<0.01), and they returned to work later than patients who were treated conservatively after grade 3 sprains. An additional rehabilitation program guided by a physiotherapist seemed to have no impact on the functional outcome. A total of 56 patients were treated by surgery. Among these patients 11 complications occurred, requiring five additional surgical procedures. Among 29 conservatively treated patients, only in 1 patient did subacromially located arthritic changes of the AC joint have to be removed.