Bradley James P, Elkousy Hussein
University of Pittsburgh Medical Center, 200 Delafield Road, Suite 4010, Pittsburgh, PA 15215, USA.
Clin Sports Med. 2003 Apr;22(2):277-90. doi: 10.1016/s0278-5919(02)00098-4.
The classification system devised by Allman and Tossy, and revised by Rockwood, defines the extent of injury to the AC joint and helps to guide management of AC joint injuries [1,4,6]. In general, type I and II injuries may be treated nonoperatively with a sling, mainly for comfort, for a short period of time. Once this is removed, strength and motion are regained with rehabilitation. Patients typically have manageable long-term symptoms without any intervention, but some may require a steroid injection or distal clavicle excision for chronic pain from degenerative changes at the AC joint due to the injury. On the other end of the spectrum, type IV, V, and VI injuries nearly always require operative intervention. The surgical procedures for these injuries are performed in the acute phase if possible to minimize symptoms and maximize long-term function. Type III injuries are the center of the controversy for management of AC joint injuries. No perfect study exists which demonstrates clear superiority of surgical or nonsurgical treatment. Most of the studies in the literature support nonoperative treatment for most patients, however. Yet, other factors must be considered, including the patient's occupation and physical demands as well as the age of the injury. Overhead athletes and manual laborers place high demands on their shoulders, prompting some authors to consider acute surgical management for these patients. We, on the other hand, agree with the current consensus opinion that all type III injuries should initially be treated conservatively, regardless of occupation. The only advantage to operative intervention consistently borne out in the literature is an increased probability of anatomic reduction. There is no correlation between reduction and improvement in pain, strength, or motion, however. These patients usually are able to return to full sport with no deficits if rehabilitation is emphasized. For those patients who fail conservative management, a multitude of surgical techniques, such as the modified Weaver-Dunn procedure, exist to reconstruct the AC joint.
由奥尔曼（Allman）和托西（Tossy）设计并经罗克伍德（Rockwood）修订的分类系统，定义了肩锁关节损伤的程度，并有助于指导肩锁关节损伤的处理 [1,4,6]。一般来说，I型和II型损伤可采用吊带非手术治疗，主要是为了短期舒适，去除吊带后，通过康复恢复力量和活动度。患者通常无需干预即可长期控制症状，但有些患者可能因损伤导致肩锁关节退变而出现慢性疼痛，需要注射类固醇或切除锁骨远端。另一方面，IV型、V型和VI型损伤几乎总是需要手术干预。如果可能，这些损伤的手术应在急性期进行，以尽量减轻症状并最大化长期功能。III型损伤是肩锁关节损伤处理争议的焦点。目前尚无完美的研究能明确显示手术或非手术治疗的明显优势。然而，文献中的大多数研究支持对大多数患者进行非手术治疗。不过，还必须考虑其他因素，包括患者的职业、身体需求以及损伤时的年龄。从事过头运动的运动员和体力劳动者对肩部要求较高，这促使一些作者考虑对这些患者进行急性手术治疗。另一方面，我们赞同目前的共识观点，即所有III型损伤最初都应采用保守治疗，无论职业如何。文献中始终证明的手术干预的唯一优势是解剖复位的可能性增加。然而，复位与疼痛、力量或活动度的改善之间并无关联。如果重视康复，这些患者通常能够毫无缺陷地完全恢复运动。对于保守治疗失败的患者，有多种手术技术，如改良韦弗 - 邓恩（Weaver-Dunn）手术，可用于重建肩锁关节。
