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。

Midshaft clavicle fracture with ipsilateral acromioclavicular joint dislocation: Key points of diagnosis analysis research

BackgroundMidshaft clavicle fracture and acromioclavicular joint dislocation are common injuries in orthopedic traumatology. The diagnosis is relatively simple and clear clinically, and missed diagnosis is rare. However, the midshaft clavicle fracture with ipsilateral acromioclavicular joint dislocation is very rare in clinical practice. Once this kind of injury occurs, the failure to make a correct diagnosis of the dislocation of the ipsilateral acromioclavicular joint in time may cause the ipsilateral shoulder joint dysfunction and even medical disputes. Therefore, it is particularly important for the early diagnosis of midshaft clavicle fracture with ipsilateral acromioclavicular joint dislocation. ObjectiveTo discuss the diagnosis of midshaft clavicle fracture with ipsilateral acromioclavicular joint dislocation, and to provide reference for early diagnosis of this kind of injury. MethodsThrough the analysis of cases reported in domestic and foreign literatures, and retrospective analysis of the follow-up cases in our department, we conducted a study investigating age, gender, injury causes, and midshaft clavicle fracture with ipsilateral acromioclavicular joint dislocation. ResultsA total of 19 English case reports of midshaft clavicle fracture with ipsilateral acromioclavicular joint dislocation and 7 Chinese document case reports were retrieved, including 22 cases with clear preoperative X-rays. In the meanwhile, we retrospectively analyzed 2 cases of this type injury during the clinical follow-up. Therefore, a total of 24 cases were included in the study. Among them, there were 16 males and 8 females. The ages ranged from 19 to 65 years old, with an average age was 37 years old. Most cases are caused by high-energy damages (21/24, 87.5%) . According to the classification of clavicle fracture, there were 19 cases (19/24, 79.2%) pf type A fractures, and 5 cases (5/24, 20.8%) of type B fractures. According to the classification of acromioclavicular joint dislocation, there were 12 cases of type IV (50.0%) , 6 cases of type III (25.0%) , 4 cases of type VI (16.7%) , and 2 cases of type V (8.3%) . There 9 cases (9/24, 37.5%) of combined injuries. ConclusionsFor relatively simple types of midshaft clavicle fractures caused by high-energy injuries, it is necessary to highly suspect whether there is ipsilateral acromioclavicular joint dislocation. The main points of diagnosis are as follows: (1) Inquire about the cause of injury in detail and understand the mechanism of injury; (2) For all cases of middle clavicle fractures, observe whether the acromioclavicular joint is swollen and subcutaneous bruising, and perform a physical examination of the acromioclavicular joint and coracoid process for tenderness. If there is tenderness, the acromioclavicular joint injury is highly suspected; (3) Carefully observe the changes of acromioclavicular joint gap and coracoclavicular gap on preoperative X-ray films. For instance, if the midshaft clavicle fracture is a relatively simple type and high-energy injury, high suspicion is required. It is recommended to take a control film as well as the CT examination of the affected shoulder joint; (4) After intraoperative fixation of the middle clavicle fracture, routine fluoroscopy of the ipsilateral acromioclavicular joint should be taken.