Ledger Michael, Leeks Nicole, Ackland Tim, Wang Allan
Department of Orthopaedic Surgery, Queen Elizabeth Medical Centre, Perth WA 6009 Australia.
J Shoulder Elbow Surg. 2005 Jul-Aug;14(4):349-54. doi: 10.1016/j.jse.2004.09.011.
The anatomic and functional effects of clavicle malunion, defined as 15 mm of shortening, were evaluated in 10 subjects. Bilateral shoulder computed tomography with 3-dimensional reconstructions was performed. A self-administered questionnaire was completed, and biomechanical testing of subjects was undertaken comparing strength and velocity of movement between shoulders. Mean shoulder scores and visual analog global assessments of shoulder function were significantly worse in the injured shoulder. Biomechanical assessment recorded a reduction in muscular strength for adduction, extension, and internal rotation of the humerus as well as a reduced peak abduction velocity in the injured shoulder (P < .05). Computed tomography assessment showed that clavicular shortening produced increased upward angulation of the clavicle at the sternoclavicular joint (P < .005) and increased anterior scapular version (P < .05). These changes in static anatomic relationships are possible mechanisms limiting shoulder function after short clavicle malunions. Consideration should be given to the prevention of shortening by open reduction and internal fixation, especially in the young, active age group.
对10名受试者评估了锁骨畸形愈合（定义为缩短15毫米）的解剖学和功能影响。进行了带有三维重建的双侧肩部计算机断层扫描。完成了一份自我管理问卷，并对受试者进行生物力学测试，比较双肩之间的运动强度和速度。受伤肩部的平均肩部评分和肩部功能视觉模拟整体评估明显更差。生物力学评估记录到受伤肩部肱骨内收、伸展和内旋的肌肉力量降低，以及外展峰值速度降低（P < .05）。计算机断层扫描评估显示，锁骨缩短导致胸锁关节处锁骨向上成角增加（P < .005）和肩胛前倾增加（P < .05）。这些静态解剖关系的变化是锁骨短缩畸形愈合后限制肩部功能的可能机制。应考虑通过切开复位内固定来预防缩短，尤其是在年轻、活跃的年龄组。
