Sons H U, Danneberg A, Jerosch J
Orthopädische Klinik und Poliklinik, Heinrich-Heine-Universität Düsseldorf.
Z Orthop Ihre Grenzgeb. 1992 Jan-Feb;130(1):22-30. doi: 10.1055/s-2008-1039508.
Luxation of the sternoclavicular joint is described on the basis of the case histories and progress of patients with this very rare form of injury who underwent surgical treatment on the Orthopedic Clinic of Düsseldorf University Hospital in the years 1978 to 1988. Four of the 6 patients in our study were subjected to a follow-up examination as out-patients. After preliminary remarks on the anatomical and biomechanical peculiarities of the sternoclavicular joint, the various types of luxation and the customary Allmann I-III classification for degree of severity are discussed. Surgical treatment is essential only for injuries of the IIIrd degree. Dislocation of the sternal end of the clavicle is most frequently found ventrad, as was also the case in all 6 patients in our study; the rarest finding is dorsad. The symptoms and the necessary diagnostic measures are described. Surgical treatment of the retrosternal luxation of the sternoclavicular joint is indicated as absolutely essential on account of the possibility of life-threatening complications. A relative indication of operative treatment exists for anterior luxation of the sternoclavicular joint where severe functional impairment and pain are present, e.g. during work and sport. The various operative methods currently in use are described. Reference is made to the importance of imaging techniques. A warning is given that, because of the risk of fatal complications, Kirschner wiring should not be used for retention of the reduction unless the K-wires are reliably secured.
本文基于1978年至1988年期间在杜塞尔多夫大学医院骨科诊所接受手术治疗的此类极为罕见损伤患者的病历和病情进展，对胸锁关节脱位进行了描述。我们研究中的6例患者中有4例作为门诊患者接受了随访检查。在对胸锁关节的解剖学和生物力学特点、各种脱位类型以及常用的Allmann I - III级严重程度分类进行初步说明后，讨论了各类脱位情况。仅III度损伤才必须进行手术治疗。锁骨胸骨端脱位最常见于向前移位，我们研究的所有6例患者均为此情况；最罕见的是向后移位。文中描述了症状及必要的诊断措施。鉴于存在危及生命并发症的可能性，胸锁关节胸骨后脱位的手术治疗被认为绝对必要。对于胸锁关节前脱位，若存在严重功能障碍和疼痛，如在工作和运动期间，则存在手术治疗的相对指征。文中介绍了目前使用的各种手术方法。提及了成像技术的重要性。同时发出警告，由于存在致命并发症的风险，除非克氏针固定可靠，否则不应使用克氏针来维持复位。
