两种不同锁骨钩置钩法在Rock-Wood Ⅲ、Ⅳ、Ⅴ型肩锁关节脱位治疗中的比较分析

目的比较分析两种不同锁骨钩置钩方法在治疗Rock-Wood Ⅲ、Ⅳ、Ⅴ型肩锁关节脱位治疗中的临床效果。 方法将本研究纳入的48例患者按治疗方式不同分为两组：采用常规置钩方式治疗24例（常规组），其中男17例、女7例，平均年龄42.4岁；采用改进置钩法治疗24例（改进组），其中男16例、女8例，平均年龄44.7岁。通过对比常规组及改进组不同置钩方法对Rock-Wood Ⅲ、Ⅳ、Ⅴ型肩锁关节脱位的治疗，比较两组在肩锁间隙、喙锁间隙的差别，并进行视觉模拟评分（visual analogue scale,VAS）及肩部功能的Constant评分。 结果所有患者获得平均13.4个月随访，改进组术后喙锁间隙与常规组术后无明显差别，在肩锁间隙上两组有明显差别，改进组在VAS及Constant评分优于常规组。 结论改进后的置钩在治疗肩锁关节脱位上与常规方法相比固定更为稳定，在减小术后肩锁关节增宽、控制肩锁关节前后移位方面有其优势，为应用锁骨钩钢板治疗Rock-Wood Ⅲ、Ⅳ、Ⅴ型肩锁关节脱位提供了新的思路。     

肩锁关节损伤合并盂肱关节周围组织损伤的调查

目的了解肩锁关节损伤合并盂肱关节周围组织损伤的情况及预后,分析讨论出现各种合并症的原因。 方法2015年1月至2018年8月收集了共52例肩锁关节损伤患者,分别记录肩锁关节损伤Rockwood分型,受伤机制,术前和术后12个月视觉模拟评分（visual analogue scale,VAS）,术后2个月、6个月、12个月Constant评分。 结果52例患者中,合并损伤占总数32.69%,其中11例患者进行了额外的手术治疗。术前、术后VAS评分比较差异无统计学意义（P>0.05）。盂肱关节合并伤手术治疗的患者,术后12个月随访,Constant评分没有明显好于未额外手术治疗的合并症患者（P>0.05）。 结论治疗肩锁关节的同时,仔细查验是否存在合并伤,并及时针对合并伤进行手术治疗,对肩关节功能恢复具有重要意义。     

Editorial Commentary: Suture Button–Anchor Fixation Is Preferable to Hook Plate Fixation for Acute Acromioclavicular Joint Dislocations: Form and Function Need to Be United

Both hook plate fixation and suture button–anchor fixation have been reported to yield good results in the treatment of acute acromioclavicular joint reconstruction. In addition to a mandatory secondary procedure, hook plate fixation clearly has an increased prevalence of post-traumatic acromioclavicular arthritis in the short term that is likely to progress in the long term. Conversely, suture button–anchor fixation—a minimally invasive technique that creates less soft-tissue disruption, does not require hardware removal, and does not violate the acromioclavicular joint—is more likely to promote primary healing of the coracoclavicular ligaments, reduce the risk of late displacement, and minimize the development of post-traumatic acromioclavicular arthritis. As stated by the noted architect Frank Lloyd Wright, it is not only about form (i.e., alignment), it is about function as well.     

Bilateral nontraumatic anterior acromioclavicular joint dislocation. A case report

An incidental finding of bilateral nontraumatic anterior acromioclavicular joint dislocation was made in a 14-year-old boy with spastic hemiparesis. Acromial processes were dislocated anterior to the distal clavicles, with characteristic radiographic findings. The dislocation is termed "anterior" because the clavicle is anatomically more proximal than the acromion. Anterior acromioclavicular joint dislocation usually is associated with significant trauma. There was no history of trauma in this case. Localized laxity of the acromioclavicular and coracoclavicular ligaments was the presumed cause of this condition, because there was no visible osseous abnormality. Since the patient was asymptomatic, no treatment was indicated.     

可调式外展架的研制及其在治疗肩锁关节脱位中的应用

目的：探索治疗肩锁关节脱位的有效方法。方法：应用自行研制的可调式外展架前瞻性地对34例新鲜肩锁关节脱位病人进行治疗，经过临床随访观察，对症状，体征及X线测量结果进行分析。结果：临床优良率达94%，X线显示喙锁距离，肩锁间距，锁骨远端移位均恢复满意。结论：可调式外展架适用于各种类型新鲜的肩锁关节脱位。     

肩锁关节脱位的治疗进展

肩锁关节脱位是临床上较为常见的脱位之一,传统多以非手术治疗为主。近年来,在对其损伤机制及分类进一步研究的基础上,大多数学者倾向于手术治疗。本文就近几年来应用于肩锁关节脱位治疗的非手术及手术治疗方法做一介绍。     

改良钛缆系统结合肩锁韧带修复治疗肩锁关节脱位

目的研究改良钛缆系统结合肩锁韧带修复治疗肩锁关节脱位临床效果。 方法对2014年1月至2019年3月期间在本院使用改良钛缆系统结合肩锁韧带修复进行治疗的21例肩锁关节脱位患者临床资料进行分析,包括脱位类型、受伤原因、手术时间、关节活动范围、X线片检查结果、美国肩肘协会评分（American shoulder and elbow surgeons,ASES）、Constant肩关节评分及Karlsson术后疗效评价。 结果21例患者获得随访,随访时间（13.05 ±2.62）个月,手术时间（50.57±8.13）min,术前等待时间（2.71±1.35）d。肩关节活动范围：前屈（167.14±5.19）°,后伸（41.14±2.20）°,外展（167.24±7.07）°,外旋（52.10±4.99）°,内旋（83.33±3.61）°。ASES评分（94.19±4.01）分（86.67 ~ 100分）,Constant评分（92.95±4.98）分（78 ~ 99分）,根据Karlsson术后疗效评价标准：优为15例（71.4%）、良为6例（28.6%）。 结论改良钛缆系统结合肩锁韧带修复技术治疗肩锁关节脱位可以获得良好的临床效果。     

Base of coracoid process fracture with acromioclavicular dislocation in a child

Fracture of the coracoid process is a rare injury. It can be easily missed when associated with other injuries to the shoulder girdle, for instance, acromioclavicular joint (ACJ) dislocation. Clinical attention is easily drawn to the more obvious ACJ dislocation, hence, the need for further radiological evaluation. We report an unusual case of fracture of the base of coracoid process associated with a true acromioclavicular joint dislocation in a 12 year old boy, with no separation of the epiphyseal plate, as one might expect. Treatment also remains controversial. Our patient underwent open reduction internal fixation of the acromioclavicular joint and coracoid process. He subsequently made an uneventful progress with pain free full range of shoulder movement at 5 months, and was discharged at 9 months.     

肩锁关节脱位手术复位中肩锁韧带的标志性作用

目的探讨肩锁关节脱位手术复位中修复肩锁韧带的作用。方法对我科2009年04月～2011年07月收治21例肩锁关节脱位采用切开复位锁骨解剖钩状钢板内固定＋肩锁韧带修补术的资料进行回顾性分析。结果本组21例手术中,19例达到肩锁韧带无张力修复,2例未能修复,可修复率达95.2%。术后21例均获得随访,根据Karlsson标准评定疗效,其中优17例,可2例,差2例。结论在肩锁关节脱位治疗中,用锁骨解剖钩状钢板内固定,同时修补喙锁韧带、肩锁韧带是治疗肩锁关节脱位的可靠方法。其中,肩锁韧带的无张力修复对肩锁关节解剖复位有很高的临床使用价值。     

Incidence of acromioclavicular joint complications after arthroscopic subacromial decompression.

We performed a chart and radiograph review of 173 patients (183 shoulders) who underwent arthroscopic subacromial decompression between 1991 and 1994 and had preoperative and postoperative radiographs. The study focused on the presence of preoperative acromioclavicular joint pathology, intraoperative violation of the acromioclavicular joint, extent of distal clavicle excision, and subsequent development of acromioclavicular joint symptoms. The 183 surgical procedures were divided into three groups: shoulders with subacromial decompression without acromioclavicular joint violation (103 of 183; 56%; group A); shoulders with subacromial decompression with acromioclavicular joint violation and partial distal clavicle resection (36 of 183; 20%; group B); and shoulders with subacromial decompression with complete distal clavicle resection (44 of 183; 24%; group C). Groups A and C had no postoperative sequelae in reference to the acromioclavicular joint. In contrast, 14 of the 36 shoulders (39%) in group B with a documented acromioclavicular joint violation and a partial distal clavicle resection developed acromioclavicular joint symptoms at an average of 8.4 months (range, 1.8 to 19 months) after surgery. This finding was statistically significant (P=.0001). The results of this study suggest that any violation of the acromioclavicular joint in the course of an arthroscopic subacromial decompression may jeopardize the result. The degree of violation is not helpful in predicting outcome. As a result of this study, we suggest an all-or-none surgical approach to the acromioclavicular joint and distal clavicle resection.     

Stand der Therapie der Schultereckgelenkverletzung Ergebnisse einer Umfrage an Unfallchirurgischen Kliniken in Deutschland

The therapy of acromioclavicular dislocations remains controversial. In particular, for injuries classified as Rockwood/Tossy Type III good results have been reported with different operative techniques as well as with conservative treatment. The objective of this study was to obtain data about the current treatment for Rockwood/Tossy III injuries in German trauma departments. In a countrywide anonymous survey 210 German trauma departments were asked about their diagnostic procedures and their treatment strategies for acromioclavicular injuries. 104 questionaires (49%) were returned and evaluated. In Rockwood/Tossy I/II injuries most clinics recommend conservative treatment (Rockwood/Tossy I/II: 99% / 87%). On the other hand, 84% of the clinics would operate on Type III acromioclavicular injuries – especially in athletes or overhead workers. Although 38 percent of the clinics believe that conservative treatment is equal or better than operative treatment, only 13 percent manage Type III injuries conservatively. For more severe acromioclavicular injuries (Rockwood IV to VI) all clinics recommend an operative treatment. The operative techniques of choice for acromioclavicular injuries are K-wire fixation (37%) or a coraco-clavicular cerclage (32%). Of the latter, 73% use a resorbable material, while the remainder use wires.     

正常国人活体肩锁关节的运动特点

目的通过3D-激光扫描照相机对肩关节运动进行扫描,了解肩锁关节的运动特点。方法通过在正常活体肩锁关节的锁骨端及肩峰端分别安装一个激光照相扫描仪的探测端子,3D-激光扫描相机扫描肩关节在做前屈、后伸、外展、内收、外旋及内旋等不同位置下两端子的位置,通过计算机计算出两端子在X、Y、Z轴（X轴代表锁骨的长轴,Y轴为冠状面与X轴垂直轴,Z轴为矢状轴）上的旋转情况。结果随着肩关节在前屈、后伸、外展、内收、外旋及内旋等不同位置时运动幅度的增大,肩锁关节的运动大部分逐渐增加,肩锁关节的X轴、Y轴和Z轴的旋转角度的运动范围分别为-2.22°～1.35°、-7.73°～2.35°和-6.67°～4.61°。结论此种方法可较好地测量肩锁关节的运动情况,同时这一技术和结果可被用于进一步研究病理性肩关节运动的改变,为研制符合肩锁关节运动特点的内固定物提供基础的生物力学数据。     

Synovial chondromatosis of the acromioclavicular joint

Summary Synovial chondromatosis involving the acromioclavicular joint is very rare. We report a case of synovial chondromatosis of the acromioclavicular joint associated with synovial cyst formation. Arthrography of the acromioclavicular joint revealed that the loose bodies lay within a synovial cyst which was in communication with the acromioclavicular joint. Synovectomy including removal of the synovial cyst and the loose bodies relieved symptoms completely. The patient was still pain- and recurrence-free at 4 years' follow-up.     

AC-Gelenkverletzungen

There is still controversy about the treatment for dislocation of the acromioclavicular joint classed as acute type III according to Tossy and Rockwood's classification.Good functional results have been reported following operative and also after nonoperative treatment. According to the literature the functional outcome is similar.Following surgical repair,however, complications are more frequent and the period of rehabilitation is longer.One complication found more frequently after nonoperative treatment is persisting prominence of the distal clavicle. According to the criteria of evidence based medicine,nonoperative treatment seems to be the method of choice for type III injuries of the acromioclavicular joint.     

A modified surgical technique for reconstruction of an acute acromioclavicular joint dislocation

We report a modified surgical technique for reconstruction of coracoclavicular and acromioclavicular ligaments after acute dislocation of acromioclavicular joint using suture anchors. We have repaired 3 consecutive type III acromioclavicular dislocations with good results. This technique is simple and safe and allows anatomical reconstruction of the ligaments in acute dislocations.     

锁骨中段骨折合并同侧肩锁关节脱位：诊断要点分析研究

目的探讨锁骨中段骨折合并同侧肩锁关节脱位的诊断要点,为临床早期诊断该类损伤提供参考。 方法通过分析国内外文献报道的病例,并回顾性分析本科室随访病例,从年龄、性别、受伤原因、锁骨中段骨折及肩锁关节脱位分型等方面进行分析。 结果共检索到19篇锁骨中段骨折伴同侧肩锁关节脱位的英文病例报道、7篇中文文献病例报道,其中有清晰术前X线片的病例共22例。同时,回顾性分析了本院临床随访的2例该类病例,因此,最终有24例病例纳入分析研究。其中,男16例、女8例;最小年龄为19岁,最大年龄为65岁,平均年龄为37岁。大部分由高能量损伤所致（21/24, 87.5%）。锁骨骨折类型分型：19例（19/24,79.2%）属于A型骨折,5例（5/24,20.8%）属于B型骨折;肩锁关节脱位分型：IV型12例（50.0%）、III型6例（25.0%）,VI型4例（16.7%）,V型2例（8.3%）;9例（9/24,37.5%）患者有合并损伤。 结论对于高能量损伤导致的相对简单类型的锁骨中段骨折,需高度怀疑有无同侧肩锁关节脱位,诊断要点如下：（1）详细询问受伤原因,了解受伤机制;（2）对所有锁骨中段骨折病例,需观察肩锁关节处有无肿胀、皮下青紫,并对肩锁关节及喙突处进行压痛体格检查,如有压痛,则高度怀疑肩锁关节损伤;（3）需仔细观察术前X线肩锁间隙及喙锁间隙变化,如锁骨中段骨折为相对简单类型,且为高能量损伤者,需高度怀疑,建议加拍对照位片及患侧肩关节CT检查;（4）术中锁骨中段骨折固定后,常规透视同侧肩锁关节。     

Biomechanics and comparison of two operative methods of treatment of complete acromioclavicular separation

Sixty-three complete acromioclavicular separations were treated by 2 operative methods. Acromioclavicular wiring gave 73% acceptable results while wire or Dacron coracoclavicular loop gave 94% acceptable results. Complications, especially broken, bent, or backed-out wires were common with acromioclavicular wiring. Of 44 patients treated by acromioclavicular wiring, 5 required late distal clavicle resection and 4 of these had retained menisci. Loop fixation is mechanically superior since the loop is in the direction of the tensile forces. In acromioclavicular wiring, however, the fixation Kirschner wires are subjected to high bending moments. Loop fixation avoids violation of the acromioclavicular joint but does not restrict rotation of the clavicle. The operation is simple to perform and postoperative immobilization is minimal. Woven Dacron may be superior to surgical wire for loop fixation in that unlike wire it does not require removal by a second operation. Woven Dacron may also stimulate coracoclavicular ligament reconstitution.     

关节镜下Twin Tail TightRope带袢钛板Y型固定治疗急性RockwoodⅢb型以上肩锁关节脱位的早期疗效

目的评价Twin Tail TightRope带袢钛板Y型固定术治疗急性肩锁关节脱位的早期临床疗效。 方法回顾性分析2015年6月至2017年6月昆明市第一人民医院采用Twin Tail TightRope带袢钛板内固定系统在关节镜下行Y型固定治疗急性肩锁关节脱位患者共16例。采用视觉模拟评分法（visual analogue scale，VAS）及Constant-Murley评分评估手术效果。 结果所有患者获得随访，随访时间3~12个月，平均（6.48±1.51）个月。术后无血管、神经损伤及切口感染，末次随访时均未发生复位丢失、锁骨应力性骨折、喙突切割等并发症。末次随访时VAS评分（0.36±0.04）分较术前（7.46±1.24）分降低，Constant-Murley评分（90.07±3.13）分较术前（46.13±3.25）分提高。 结论采用Twin Tail TightRope带袢钛板Y型固定术治疗急性肩锁关节脱位可有效解决术后水平、前后方向不稳定问题，此技术具有较低的锁骨、喙突骨折发生率，关节镜下操作可以减少手术损伤、提高精准度。     

The management of acute acromioclavicular dislocation. A randomised prospective controlled trial

In a prospective study, 60 patients with acute acromioclavicular dislocation were randomly allocated to treatment with a broad arm sling or to reduction and fixation with a coracoclavicular screw. Of these 54 were followed for four years. Conservatively-treated patients regained movement significantly more quickly and fully, returned to work and sport earlier and had fewer unsatisfactory results than those having early operation. For severe dislocations, with acromioclavicular displacement of 2 cm or more, early surgery produced better results. Conservative management is best for most acute dislocations, but younger patients with severe displacement may benefit from early reduction and stabilisation.     

Central K-wire and PDS-Cord for Acromioclavicular separations – a successful treatment?

Beside the basic question wether a separation of the acromioclavicular joint should be treated operatively or not, the method of operation is discussed in particular. For that reason we investigated our own method of a temporary transfixation of the joint by a centrally drilled K-wire combined with a PDS-augmentation of the coracoclavicular and a suture of the acromioclavicular ligament. Follow up examinations were possible in 57 out of 82 patients which were operated during 5 years. Patients subjective rating and objective follow up and sonographically evaluated joint conditions were scored together. Looking for the range of motion of the shoulder only 5.5% of the patients had a reduction of more than 20 degrees. Out of 12 complications in particular three infections only resulted satisfying by influencing the subjective rating negatively. In 28.1% of patients no durable anatomic reconstruction of the joint was achieved. Score achieved by these patients was significantly lower compared to those with a lasting anatomic reconstruction of the acromioclavicular joint. In conclusion the results confirm our operative regime for separations of the acromioclavicular joint. In literature survey the here described method of operation belongs to the better ones without showing a clear advantage. Nevertheless the method should be modified to decrease the rate of subluxations.