RÉSUMÉ
Acromioclavicular joint dislocation is a common shoulder injury caused by injuries to the acromioclavicular and coracoclavicular ligaments, which may result in pain and limited mobility in the affected shoulder. Currently, hook plate fixation is commonly used to treat Rockwood type III-VI acromioclavicular joint dislocation in clinical settings. However, there are complications such as subacromial impingement and osteolysis. Therefore, the treatment has gradually shifted from rigid fixation to elastic fixation, with a preference for reconstruction of the coracoclavicular ligament. The internal fixation with the Endobutton system allows for micro-movement of the acromioclavicular joint, but its loop length can′t be freely adjusted. The Tightrope system is developed based on the improvement of the Endobutton system, which has been increasingly used in clinical settings in recent years, with the advantages of easy operation, adjustability and minimal trauma. However, postoperative complications such as clavicular and/or coracoid fractures and loss of reduction are prone to occur. To date, there are various and inconsistent treatment plans of internal fixation with Tightrope system for acromioclavicular joint dislocation, and their clinical effects vary. To this end, the authors reviewed the structure, biomechanics, surgical techniques, and therapeutic effects of the internal fixation with Tightrope system in the treatment of acromioclavicular joint dislocation, aiming to provide a reference for the selection of its clinical treatment.
RÉSUMÉ
Objective To compare the short-term efficacy of AC TightRope plate and clavicular hook plate in the treatment of acromioclavicular joint dislocation.Methods A retrospective case control study was conducted to analyze the clinical data of 32 patients with acromioclavicular joint dislocation admitted to Yifu Hospital Affiliated to Nanjing Medical University from April 2016 to December 2017.There were 23 males and 9 females,aged 26-61 years [(43.5 ±9.5)years].According to Rockwood classification,there were 23 patients with type Ⅲ and 9 patients with type Ⅴ.The patients were divided into AC TightRope group and clavicular hook plate group according to different treatment methods.There were 17 patients in AC TightRope group,including 12 males and 5 females,aged (42.6 ± 10.3)years.There were 15 patients in clavicular hook plate group,including 11 males and 4 females,aged (44.5 ± 8.9)years.The incision length,operation time,intraoperative blood loss,hospitalization time,postoperative visual analogue scale (VAS) of the affected shoulder,functional recovery of shoulder joint and complications were compared between the two groups.Results All patients were followed up for 6-26 months,with an average of 15 months.There was no significant difference between the two groups in hospitalization time (P ＞ 0.05).In the AC TightRope group and clavicular hook plate group,the operation time was (41.5 ±4.2)minutes and (60.1 ± 4.2) minutes,respectively (P ＜ 0.01);the incision length was (3.6 ± 0.3) cm and (10.1 ± 0.6) cm,respectively (P ＜ 0.01);the intraoperative blood loss was (45.3 ± 11.1) ml and (78.3 ± 16.0) ml,respectively (P ＜ 0.01);the postoperative VAS of the shoulder was (1.9 ± 0.5) points and (3.1 ± 0.7) points,respectively (P ＜ 0.05);the excellent and good rate of postoperative recovery of shoulder joint function was 100％ (17/17) and 67％ (10/15),respectively (P ＜0.01).There were no complications such as surgical incision infection,intraoperative neurovascular injury or condylar fracture during the perioperative period.No serious postoperative complications such as internal fixation loosening,loss of reduction or recurrence of dislocation were found in both groups.Conclusion For acromioclavicular joint dislocation,AC TightRope can obtain good clinical effect and has obvious advantages in operation time,incision length and blood loss,with lower incidence of shoulder pain and better functional recovery compared with clavicular hook plate.