喙锁韧带部分损伤的生物力学与影像学分析
Biomechanical and radiographic analysis of partial coracoclavicular ligament injuries.
作者信息
Mazzocca Augustus D, Spang Jeffrey T, Rodriguez Rudy R, Rios Clifford G, Shea Kevin P, Romeo Anthony A, Arciero Robert A
机构信息
Department of Orthopaedics, Medical Arts and Research Building, University of Connecticut Health Center, 10 Talcott Notch Road, Farmington, CT 06030, USA.
出版信息
Am J Sports Med. 2008 Jul;36(7):1397-402. doi: 10.1177/0363546508315200. Epub 2008 Mar 28.
BACKGROUND
A spectrum of acromioclavicular joint injuries may exist between type II acromioclavicular joint disruption (coracoclavicular strain) and type III acromioclavicular joint injuries (coracoclavicular disruption). This may help explain the variability in outcomes seen in patients with type II acromioclavicular injuries.
HYPOTHESIS
Injury to either the conoid or trapezoid ligaments would lead to instability of the acromioclavicular joint after complete acromioclavicular joint injury. A secondary hypothesis was that the resulting instability could be recognized with Zanca radiographs.
STUDY DESIGN
Controlled laboratory study.
METHODS
The acromioclavicular ligaments were sectioned in 40 cadaveric shoulder specimens. Ten intact specimens were loaded to failure to evaluate the normal failure patterns of the coracoclavicular ligaments. Thirty specimens then had either the conoid or trapezoid ligament sectioned after creation of complete acromioclavicular joint injury. Preinjury and postinjury radiographs and stability testing quantified the effect of coracoclavicular joint injury on acromioclavicular joint stability.
RESULTS
During failure testing, the conoid always failed first. Sectioning of the conoid led to significant increases in posterior and superior displacement on radiographs and with materials testing. Sectioning of the trapezoid led to significant increases in posterior displacement for materials testing and superior displacement on radiographs.
CONCLUSION
Sectioning of the acromioclavicular ligaments in conjunction with partial disruption of the coracoclavicular ligament complex led to significant changes in both radiographic and mechanical measures of acromioclavicular stability. The conoid fails first when a load is applied to the coracoclavicular complex in a superior direction.
CLINICAL RELEVANCE
Zanca radiograph may detect incomplete injury to the coracoclavicular ligaments associated with acromioclavicular disruption.
背景
在II型肩锁关节脱位（喙锁韧带拉伤）和III型肩锁关节损伤（喙锁韧带断裂）之间可能存在一系列肩锁关节损伤情况。这或许有助于解释II型肩锁关节损伤患者预后的差异。
假设
在肩锁关节完全损伤后，圆锥韧带或斜方韧带损伤会导致肩锁关节不稳定。第二个假设是，由此产生的不稳定可以通过赞卡氏位X线片识别出来。
研究设计
对照实验室研究。
方法
在40个尸体肩部标本中切断肩锁韧带。对10个完整标本加载直至破坏，以评估喙锁韧带的正常破坏模式。然后在造成肩锁关节完全损伤后，对30个标本切断圆锥韧带或斜方韧带。损伤前后的X线片和稳定性测试量化了喙锁关节损伤对肩锁关节稳定性的影响。
结果
在破坏测试过程中，圆锥韧带总是首先断裂。切断圆锥韧带导致X线片上以及材料测试中后向和上向移位显著增加。切断斜方韧带导致材料测试中后向移位以及X线片上的上向移位显著增加。
结论
切断肩锁韧带并伴有喙锁韧带复合体部分断裂会导致肩锁关节稳定性的影像学和力学指标发生显著变化。当向上方对喙锁复合体施加负荷时，圆锥韧带首先断裂。
临床意义
赞卡氏位X线片可能检测出与肩锁关节脱位相关的喙锁韧带不完全损伤。
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