Simovitch Ryan, Sanders Brett, Ozbaydar Mehmet, Lavery Kyle, Warner Jon J P
Palm Beach Orthopaedic Institute, Palm Beach Gardens, FL 33410, USA.
J Am Acad Orthop Surg. 2009 Apr;17(4):207-19. doi: 10.5435/00124635-200904000-00002.
Acromioclavicular joint injuries represent nearly half of all athletic shoulder injuries, often resulting from a fall onto the tip of the shoulder with the arm in adduction. Stability of this joint depends on the integrity of the acromioclavicular ligaments and capsule as well as the coracoclavicular ligaments and the trapezius and deltoid muscles. Along with clinical examination for tenderness and instability, radiographic examination is critical in the evaluation of acromioclavicular joint injuries. Nonsurgical treatment is indicated for type I and II injuries; surgery is almost always recommended for type IV, V, and VI injuries. Management of type III injuries remains controversial, with nonsurgical treatment favored in most instances and reconstruction of the acromioclavicular joint reserved for symptomatic instability. Recommended techniques for stabilization in cases of acute and late symptomatic instability include screw fixation of the coracoid process to the clavicle, coracoacromial ligament transfer, and coracoclavicular ligament reconstruction. Biomechanical studies have demonstrated that anatomic acromioclavicular joint reconstruction is the most effective treatment for persistent instability.
肩锁关节损伤占所有运动性肩部损伤的近一半，通常是由于手臂内收时肩部尖端着地摔倒所致。该关节的稳定性取决于肩锁韧带和关节囊以及喙锁韧带、斜方肌和三角肌的完整性。除了进行压痛和不稳定的临床检查外，影像学检查在肩锁关节损伤的评估中至关重要。I型和II型损伤采用非手术治疗；IV型、V型和VI型损伤几乎总是建议手术治疗。III型损伤的治疗仍存在争议，大多数情况下倾向于非手术治疗，而肩锁关节重建仅用于有症状的不稳定情况。对于急性和晚期有症状的不稳定情况，推荐的稳定技术包括将喙突固定到锁骨的螺钉固定、喙肩韧带转移和喙锁韧带重建。生物力学研究表明，解剖学肩锁关节重建是治疗持续性不稳定的最有效方法。
