外科医生认为Rockwood分类是决定急性、高度肩锁关节脱位的最重要因素

IF 2.7 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2025-03-13 DOI:10.1002/jeo2.70203

Eduard Van Eecke, Arno Alexander Macken, Derek van Deurzen, Thibault Lafosse, Antoon van Raebroeckx, Geert Alexander Buijze, Michel van den Bekerom, AC Instability Collaborator Group

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引用次数: 0

摘要

目的本研究的目的是探讨患者特异性因素，包括年龄、生活方式考虑以及Rockwood分类（RW）的损伤程度，对外科医生选择手术还是非手术治疗急性、高度肩锁关节脱位（AC）的影响。方法要求骨科和创伤外科医生完成一份在线调查问卷，包括关于急性、高度AC关节脱位的治疗和24个有效的临床场景的封闭式和开放式问题。结果共回收问卷133份。来自五大洲的27个不同国家的代表出席了会议。纳入的参与者的平均经历为12年（四分位数范围：2-41）。总的来说，选择手术治疗方案的有2426人（76%），而选择“否”的有766人（24%）。大多数外科医生（69%）认为RW分类是影响手术决策的最重要因素。三分之二的参与者回答说吸烟不会影响他们对手术的决定，至于身体质量指数（BMI）对决策的影响，一半的受访者不会根据BMI改变他们的首选治疗方法。最后，关于参与者人口统计的影响，在决策方面没有显着差异。结论本研究强调RW分型是外科医生决定对急性高度AC关节脱位进行手术还是非手术治疗时最重要的考虑因素。在76%的病例中，参与者更倾向于手术治疗而非非手术治疗急性高度AC关节脱位，当不考虑RW III级病变时，这一比例增加到90%。这些发现与最近报道保守治疗急性高级别AC损伤的良好功能结果的研究形成对比，并强调需要弥合证据与实践之间的差距。证据等级V级。

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Surgeons consider Rockwood classification the most important factor for decision-making in acute, high-grade acromioclavicular dislocations

Purpose

The aim of this study is to investigate the influence of patient-specific factors, including age, lifestyle considerations as well as the extent of injury according to the Rockwood classification (RW), on the surgeon's decision-making in the choice between operative and nonoperative treatment for acute, high-grade acromioclavicular (AC) joint dislocations.

Methods

Orthopaedic and trauma surgeons were requested to complete an online questionnaire consisting of closed and open questions regarding the treatment of acute, high-grade AC joint dislocations and 24 fictive clinical scenarios.

Results

A total of 133 answered questionnaires were collected. 27 different nationalities from five continents were represented. The included participants had a median experience of 12 years (interquartile range: 2–41). Overall, the treatment option for surgery (answer: YES) was chosen in 2426 answers (76% of cases) compared to ‘NO’ in 766 (24% of cases). RW classification was considered the most important factor influencing surgical decision-making for most surgeons (69%). Two thirds of the participants answered that smoking does not impact their decision towards surgery and as to the influence of body mass index (BMI) on decision-making, half of the respondents would not alter their preferred treatment based on BMI. Finally, there were no significant differences in decision-making regarding the influence of the participant's demographics.

Conclusion

This study highlights that RW classification is the most important factor to consider in the surgeon's decision-making between operative and nonoperative treatment in acute, high-grade AC joint dislocations. Participants preferred operative treatment over nonoperative treatment in acute, high-grade AC joint dislocation in 76% of case scenarios, increasing up to 90% when RW Grade III lesions were not taken into account. These findings contrast with recent studies reporting good functional outcomes of conservatively treated acute, high-grade AC injuries and highlight the need to bridge the gap between evidence and practice.