Scarlat M M, Cuny C, Goldberg B A, Harryman D T, Matsen F A
Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Général, Hyères-les-Palmiers, France.
Int Orthop. 1999;23(5):302-7. doi: 10.1007/s002640050376.
17 patients had radiographic demonstration of injury to the clavicle, scapula and ribs from an impact delivered to the lateral shoulder. The study included 13 males and 4 females whose ages ranged from 18 to 83 years (average 45 years). Most injuries were sustained in falls or motor vehicle accidents. Analysis of these cases suggests a biomechanical hypothesis concerning the transmission of the impact forces within the shoulder girdle. According to this hypothesis, the impaction force applied to the lateral shoulder is transmitted from outside inward following two paths. The anterior and superior path passes through the acromio-clavicular joint, the clavicle, the costo-clavicular joint and the sterno-clavicular joint. The posterior and inferior path is transmitted within the gleno-humeral joint, the scapula and the scapulo-thoracic joint. Major impacting force is required to disrupt the anterior and posterior arches of the shoulder girdle. When both of these supporting structures are damaged, the patient is at risk for more serious injuries, including disruption of the thorax, shoulder joint, brachial plexus and neck.
17名患者经影像学检查显示，因肩部外侧受到撞击，导致锁骨、肩胛骨和肋骨损伤。该研究纳入了13名男性和4名女性，年龄在18岁至83岁之间（平均45岁）。大多数损伤是在跌倒或机动车事故中发生的。对这些病例的分析提出了一个关于肩带内冲击力传递的生物力学假说。根据这一假说，施加于肩部外侧的撞击力通过两条路径从外向内传递。前上方路径穿过肩锁关节、锁骨、肋锁关节和胸锁关节。后下方路径在盂肱关节、肩胛骨和肩胛胸壁关节内传递。破坏肩带的前后弓需要较大的撞击力。当这两个支撑结构都受损时，患者有发生更严重损伤的风险，包括胸部、肩关节、臂丛神经和颈部的损伤。
