Les disjonctions sterno-claviculaires

Résumé Quarante-neuf disjonctions sterno-claviculaires dont deux décollements épiphysaires sont étudiées. 55% des patients ont été réévalués avec un recul moyen de 6,7 ans, 15 entre 2 et 6 ans et 12 entre 6 et 16 ans après la lésion. La disjonction n'était isolée que dans 41% des cas. Cette série comporte 40 disjonctions antérieures, 8 disjonctions rétrosternales et 1 instabilité multi-directionnelle. Dissept ont été opérées, 17 négligées et 15 fois un traitement orthopédique par plâtre ou écharpe a été appliqué. Le résultat est acquis en moyenne en trois mois et ne se modifie plus à long terme. Dans un quart des cas persistent des séquelles diverses. 42% des patients ont un excellent résultat, 58% sont satisfaits mais 25% déçus du traitement. Le traitement chirurgical donne le plus grand nombre d'excellents résultats (66%) et l'immobilisation, surtout lorsque la lésion n'est pas réduite, le plus grand nombre de mauvais résultats (19%). L'association à d'autres lésions de la ceinture scapulaire (55%) ou du thorax (37%) est caractéristique de ces disjonctions dont le pronostic est fonction du sens du déplacement et de la qualité de la réduction. Le traitement orthopédique s'impose toujours initialement, mais l'échec de la réduction doit conduire à l'intervention. Les lésions invétérées mal tolérées bénéficient d'une stabilisation par myoplastie, ou d'une résection du quart interne de la clavicule si les surfaces articulaires sont pathologiques.

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Dislocation of the sternoclavicular jointA review of 49 cases

Summary Over a period of 19 years, 49 dislocations of the sternoclavicular joint were treated. Two were epiphyseal separations. The dislocation was an isolated injury in only 41% of the patients. There were associated injuries to the scapula in 55% and to the thorax in 37%. Forty dislocations were anterior, 8 retrosternal and one merely unstable. Seventeen were treated by operation, 15 by closed reduction and 17 were left untreated. We have been able to review 55% of these patients with an average follow up of 6.7 years; 15 were between 2 and 6 years after injury, and 12 between 6 and 16 years. The end result was achieved by 3 months; 42% of patients had an excellent result, 58% were satisfied and 25% disappointed with the final outcome. Operative treatment gave 66% of excellent results, whereas immobilisation, particularly with unreduced dislocations, accounted for most of those judged unsatisfactory.Closed treatment should be undertaken initially, but if reduction is not achieved an operation should be carried out. If old unreduced dislocations are unsatisfactory they should be stabilised by myoplasty, or by excision of the inner end of the clavicle if the articular surface is damaged.

     

Sternoclavicular joint septic arthritis and mediastinitis. A case report and review of the literature

Septic arthritis of the sternoclavicular joint is rare. Its causes have been reported to include immuno-compromizing diseases, intravenous drug abuse, fractures of the clavicle or catheterization of the subclavian vein. We report a case of septic arthritis of the SCJ in a diabetic patient following periarticular injection of steroids in the ipsilateral shoulder, as this route of infection has not been documented, to our knowledge, in the literature to date. We review the literature regarding epidemiology and methods of surgical treatment that have been proposed, and present our own surgical experience. Bacterial infection should always be suspected in cases of SCJ arthritis. If surgery is required, it is important to remember that bony procedures leave vascular structures exposed, making their cover by myoplasty mandatory.     

切降性胸锁关节成形术治疗胸锁关节脱位

目的：探讨切除性胸锁关节成形术治疗胸锁关节脱位的临床应用可行性。方法：采用切除性胸锁关节成形术和修复或重建肋锁韧带治疗5例胸锁关节脱位的病例,并对结果进行平均1．8年随访、评价。结果：全部病例均随访平均1．8年,所有病人均获优秀效果,无感染、疼痛、畸形。结论：我们认为切除性胸锁关节成形术,保留或重建肋锁韧带是治疗胸锁关节脱位疗效可靠的方法。     

胸锁钩钢板治疗胸锁关节脱位的临床观察

目的:观察应用胸锁钩钢板治疗胸锁关节脱位患者的临床治疗效果。方法:2010年6月至2012年6月对7例胸锁关节脱位患者行胸锁钩钢板复位固定术治疗,其中男5例,女2例;年龄38～54岁,平均42.3岁;病程1～4周。术前患者均有外伤史,患侧胸锁关节肿胀、疼痛明显,患侧肩关节活动明显受限。术前X线片及CT证实为胸锁关节脱位,根据Rockwood评分法对术后疗效进行评价。结果:本组7例胸锁关节脱位患者按Rockwood评分法进行评价,优6例,良1例。术后未出现内固定松动、断裂,未出现再次脱位,肩关节功能良好,胸锁关节无疼痛,外观无畸形,患肢活动自如无疼痛。结论:胸锁钩钢板治疗胸锁关节脱位,手术操作简单,固定可靠,疗效肯定,值得临床推广。     

创伤性胸锁关节损伤的诊断及治疗方法的选择（附69例报道）

目的：通过对创伤性胸锁关节损伤解剖结构的改变、致伤机理,诊断及不同治疗方法的研究。而寻求一种简便、有效的治疗方法,方法：69例71个创伤性胸锁关节,其中半脱位14个,新鲜脱位36个,陈旧性脱位13个,骨骺骨折8个,应用非手术治疗和手术治疗。随访6-18个月。结果：非手术治疗48个关节。47个关节功能正常,不伴疼痛等不适;手术治疗23个关节。17个关节功能正常,6个关节功能受限伴或不伴疼痛等不适。结论：非手术治疗是创伤性胸锁关节损伤首选治疗方法。且新鲜损伤优于陈旧性损伤,因此对创伤性胸锁关节损伤要求尽早诊断及治疗,以提高治疗效果。     

Bilateral spontaneous atraumatic anterior subluxation of the sternoclavicular joint

Abstract I report a case of bilateral spontaneous atraumatic anterior subluxation of the sternoclavicular joint in a 19-year-old woman without any known underlying pathology. There was no history of injury. The patient was treated conservatively. One year later the patient was asymptomatic and had returned to her usual activities.     

Hypertrophy of the sternoclavicular joint after functional neck dissection

Sternoclavicular joint hypertrophy is anecdotally reported as a common sequela to radical neck dissection. It is postulated that sternoclavicular joint hypertrophy is a result of a combination of spinal accessory nerve division and sternocleidomastoid muscle resection during radical neck dissection. However, we noticed that sternoclavicular joint hypertrophy can occur following functional neck dissection with preservation of the spinal accessory nerve, the sternocleidomastoid muscle and the internal jugular vein. Regardless of the aetiological factors that can lead to sternoclavicular joint hypertrophy, we believe that plain radiography and ultrasound examination of the joint, with or without fine needle aspiration or core biopsy may rule out bone metastasis with no need for further investigations. We wish to present a case of sternoclavicular joint hypertrophy following functional neck dissection to highlight the point that sternoclavicular joint hypertrophy is not solely related to division of the spinal accessory nerve and/or the sternocleidomastoid muscle.     

T形钢板内固定治疗胸锁关节前脱位

胸锁关节脱位根据锁骨内端移位的方向可分为前脱位及后脱位,其中前脱位最常见,后脱位较少见。传统治疗方法多为保守治疗,因其复位容易但固定难多失败,而对手术治疗及术式的选择,也常是临床医生感到棘手的问题。2003年7月至2007年5月,共收治胸锁关节前脱位9例,用“T”形钢板内固定治疗取得了较好效果。     

锁骨钩钢板治疗不稳定性胸锁关节脱位

目的 探讨锁骨钩钢板切开复位治疗不稳定性胸锁关节脱位的临床意义及疗效. 方法 2005年4月至2007年10月,采用切开复位锁骨钩钢板内固定治疗19例不稳定性胸锁关节脱位患者,根据Grade分型:Ⅱ型2例,Ⅲ型17例.全部采用患侧切开复位锁骨钩钢板内固定术加关节成形术并修补肋锁韧带、胸锁韧带. 结果术后均尤再脱位,钢板尤断裂、松动、脱钩等现象.所有患者均获随访,时间6～24个月,平均8个月;愈合时间3～6周,平均4周.按照Rockwood胸锁关节评分标准:优16例,良2例,可1例,优良率为94.7%.术后患者均恢复解剖结构及外观,功能满意.结论 锁骨钩钢板内固定治疗小稳定性胸锁关节脱位具有操作简便安全、创伤小、固定可靠等优点,并有较好的维持复位和促进恢复作用,术后患者功能及外观恢复满意.     

Superior sternoclavicular joint dislocation presented with shoulder motion limitation: A case report and literature review

Introduction and importanceSternoclavicular joint dislocation accounts for 1 percent of the human joint dislocations. Sternoclavicular joint dislocation most commonly occurs in anterior or posterior dislocation. To the best of the authors knowledge, only six cases of superior sternoclavicular joint dislocation are reported in the literature. The injury is commonly missed.Case presentationWe present a 28-year-old athlete with upper chest pain and right shoulder range of motion limitation. On imaging, it was revealed that he had a superior sternoclavicular dislocation. He was managed with arm sling, analgesics and physiotherapy. After 3 months, he was asymptomatic and returned to his sport activity successfully.Clinical discussionWe searched the published related studies and summarized the signs and symptoms of patients presented with sternoclavicular dislocation. Chest pain is one of the most common symptom while sternoclavicular tenderness and restriction of shoulder movement are among the most common signs of sternoclavicular dislocations. Conservative, close reduction, and open reduction and internal fixation with fiber wire have been applied for cases with superior sternoclavicular dislocation with acceptable results.ConclusionA high index of suspicion is needed in order not to miss sternoclavicular dislocation. In cases with no evidence of mediastinal structure compression it may be managed conservatively successfully. However, some degree of cosmetic deformity may remain at the sternoclavicular joint in those treated with conservative therapy.     

Sternoclavicular joint dislocation and its management: A review of the literature

Dislocations of the sternoclavicular joint(SCJ) occur with relative infrequency and can be classified into anterior and posterior dislocation, with the former being more common. The SCJ is inherently unstable due to its lack of articular contact and therefore relies on stability from surrounding ligamentous structures, such as the costoclavicular, interclavicular and capsular ligaments. The posterior capsule has been shown in several studies to be the most important structure in determining stability irrespective of the direction of injury. Posterior dislocation of the SCJ can be associated with life threatening complications such as neurovascular, tracheal and oesophageal injuries. Due to the high mortality associated with such complications, these injuries need to be recognised acutely and managed promptly. Investigations such as x-ray imaging are poor at delineating anatomy at the level of the mediastinum and therefore CT imaging has become the investigation of choice. Due to its rarity, the current guidance on how to manage acute and chronic dislocations is debatable. This analysis of historical and recent literature aims to determine guidance on current thinking regarding SCJ instability, including the use of the Stanmore triangle. The described methods of reduction for both anterior and posterior dislocations and the various surgical reconstructive techniques are also discussed.     

Surgical treatment of sternoclavicular joint infections in cirrhotic patients

BACKGROUND: Cirrhotic patients with sternoclavicular joint (SCJ) infection pose a unique challenge for which there are no management guidelines. We reviewed our experience with this unusual infection in this high-risk patient population. METHODS: We performed a retrospective analysis of all patients with cirrhosis (n = 5) treated surgically for SCJ infection from January 1998 to July 2006. RESULTS: All infections were locally advanced with bone necrosis, complex abscess formation, or mediastinal involvement. En bloc SCJ resection was performed in 3 patients. A more conservative approach of incision and drainage with debridement was performed in 2 patients. Sepsis and/or pulmonary compromise occurred in all patients postoperatively and the surgical mortality rate was 40%. All deaths occurred after en bloc SCJ resection. CONCLUSIONS: Sternoclavicular joint infections in cirrhotic patients tend to be extensive in nature and pose a high surgical risk. Adequate surgical drainage and debridement may be better tolerated than a radical en block resection.     

Spontaneous atraumatic dislocation of sternoclavicular joint in Reiter's syndrome

Reactive arthritis or Reiter's syndrome characteristically affects the joint of the lower limb in an asymmetrical pattern.Usually it does not affect the axial skeleton or upper limbs.Although cases of ...     

锁骨钩钢板与张力带固定治疗胸锁关节脱位的病例对照研究

目的:对比分析锁骨钩钢板与张力带固定治疗AllmanⅡ～Ⅲ型胸锁关节脱位的临床疗效。方法:回顾性分析2000年5月至2008年9月手术治疗的31例AllmanⅡ～Ⅲ型胸锁关节脱位患者的资料,其中锁骨钩钢板固定组(A组)16例,男11例,女5例,平均年龄(37.4±7.3)岁;张力带固定组(B组)15例,男9例,女6例,平均年龄(35.6±5.1)岁。分别对两组患者术中、住院期间各项指标,及术后并发症发生率、术后疗效进行对比分析。结果:全部患者获随访,时间12～37个月,平均20个月。两组在手术时间、术中失血量、手术切口长度方面比较差异无统计学意义(P0.05),在费用方面A组明显高于B组。并发症:A组2例,B组8例,两组比较P=0.023,A组少于B组。术后疗效评定根据Rockwood标准:A组优13例,良2例,可1例,差0例;B组优10例,良3例,可1例,差1例;两组比较P=0.600,差异无统计学意义。结论:两种疗法治疗AllmanⅡ～Ⅲ型胸锁关节脱位的手术创伤及术后疗效相当,但锁骨钩钢板固定具有并发症低、利于早期功能锻炼等优点。     

化脓性胸锁关节炎的手术治疗

目的 探讨化脓性胸锁关节炎的手术治疗效果。方法 我院自2010年2月至2015年4月共收治化脓性胸锁关节炎病人12例,年龄为31~83岁,平均55.2岁;均为男性。其中5例病人CT或MRI扫描显示脓肿包绕胸锁关节但没有骨侵袭,采用单纯清创、引流术;其余7例病人CT或MRI检查显示骨破坏或有骨髓炎的影像学征像,采用扩大清创引流+胸锁关节部分切除术。手术前后采用Constant评分对肩关节功能进行评估,术前肩关节Constant评分为69~94分,平均76.5分。结果 病人手术时间为67~320 min,平均124.5 min;出血量为200~1 200 ml,平均450.0 ml;输血量为0~600 ml,平均158.3 ml。所有病人获得24~36个月的随访,切口均Ⅰ期愈合,无再感染征象,无肩关节活动障碍。末次随访时,肩关节Constant评分为67~93分（平均78.0分）,与术前比较,差异无统计学意义（Z=0.0001,P＞0.05）。结论 化脓性胸锁关节炎是少见、特殊的胸部骨关节感染,及早诊断、治疗非常重要,多数病人经正规抗感染和手术治疗后,远期肩关节功能预后良好。     

闭合性胸锁关节脱位合并金黄色葡萄球菌感染1例

正患者,男,60岁,重物压砸致上胸部疼痛2周,呼吸困难3 d入院。患者2周前搬抬重物时不慎被砸中上胸部,当即出现上胸部疼痛,右肩活动时疼痛加重。在当地医院就诊予以对症治疗(具体过程不详),患者症状无明显缓解。3 d前出现呼吸困难,于我院急诊科行CT检查示右侧包裹性胸腔积液,右胸锁关节脱位。以右胸锁关节脱位,右侧包裹性胸腔积液收入院。     

锁骨钩钢板在胸锁关节脱位治疗中的应用

目的:探讨应用锁骨钩钢板治疗胸锁关节脱位的方法及疗效。方法:2010年1月至2014年3月,采用锁骨钩钢板固定治疗胸锁关节脱位患者6例,其中男5例,女1例;年龄26～48岁,平均34岁;病程3～20 d.患者均为外伤后患侧胸锁关节肿胀、疼痛,患侧肩关节活动明显受限,经X线片及CT诊断为胸锁关节前脱位,根据Rockwood评分法对术后疗效进行评价。结果:所有患者术后切口愈合良好,外观美观;X线片显示胸锁关节脱位复位良好,钢板位置良好。6例患者均获随访,时间4～18个月,平均12个月。根据Rockwood评分法进行疗效评定:优4 例,良 1 例,可 1 例,未见内固定失效及再脱位,无血管、神经及胸膜等副损伤。结论:锁骨钩钢板能在复位固定胸锁关节的同时保留胸锁关节微动功能,且不损伤胸锁关节软骨面。手术安全性高,固定效果好,患者术后可进行早期康复锻炼。     

锁骨近端骨折的手术治疗方法及分型探讨

目的：总结不同锁骨近端骨折的手术治疗方法并探讨锁骨近端骨折的分型。方法：2017年1月至2020年12月收治24例移位型锁骨近端骨折患者,男16例,女8例;年龄28~66岁;其中新鲜骨折20例,陈旧性骨折4例。骨折Edinburgh分型,1B1型14例,1B2型10例。根据不同骨折分型选择不同的内固定方式进行内固定治疗。记录手术时间、失血量、术前后移位差异、骨折愈合时间及Rockwood评分结果。结果：24例患者获得随访,时间12~24个月。术后无感染、复位丢失情况发生,有3例患者出现内固定失效断裂退钉情况,取出内固定装置。手术时间30~65 min,失血量15~40 ml。无重要神经血管脏器损伤。影像学愈合时间3~6个月。末次随访Rockwood功能评分（13.50±1.86）分,疼痛（2.57±0.50）分、活动范围（2.78±0.41）分、肌肉强度（2.93±0.28）分、日常活动受限（2.85±0.35）分、主观结果（2.63±0.61）分,其中优20例,良3例,可1例。结论：锁骨近端骨折是一种发生率较低的骨折类型,针对不同的骨折分型可对应选择不同内固定方法及治疗方式,均取得较为满意的手术效果。     

胸锁关节脱位合并肩锁关节脱位伴肩胛骨喙突骨折漏诊1例

<正>患者,女,55岁,因跌伤致右肩疼痛活动受限2 h收住入院。患者2 h前骑车时跌倒,右侧头面部及右肩着地,急诊摄X线片示右胸锁关节脱位。入院查体:右锁骨胸骨端局部隆起、压痛,可及弹性固定,平卧时隆起变小,坐起时明显,右手各指感觉活