Wellmann M, da Silva G, Lichtenberg S, Magosch P, Habermeyer P
Klinik für Orthopädie, Medizinische Hochschule Hannover im Annastift, Anna von Borries Str. 1-6, 30625 Hannover, Deutschland.
Orthopade. 2013 Apr;42(4):271-7. doi: 10.1007/s00132-013-2085-1.
There is no evidence-based treatment algorithm established for acromioclavicular joint (AC joint) dislocation classified as type Rockwood III injury. Recent meta-analyses revealed no advantage of surgical treatment compared to the non-operative approach. Both surgical and non-surgical approaches have been reported with inconsistent results. Therefore, the hypothesis of the current study was that patients classified as having Rockwood grade III injury may have different degrees of horizontal AC joint instability.
A total of 18 consecutive patients who had sustained a dislocation of the AC joint classified as Rockwood III were evaluated radiologically to quantify the horizontal instability of the AC joint. The specific radiological investigation included lateral stress x-rays (Alexander view) und axial stress x-rays with the affected arm in a horizontal adduction position.
The dynamic horizontal instability of the AC joint was found to be independent of the vertical dislocation measured in the Rockwood classification.
For further treatment studies Rockwood III injuries should be distinguished in patients presenting with or without a substantial horizontal AC joint instability.
对于归类为Rockwood III型损伤的肩锁关节脱位，尚无基于证据的治疗方案。最近的荟萃分析显示，与非手术治疗相比，手术治疗并无优势。手术和非手术治疗方法的结果均不一致。因此，本研究的假设是，归类为Rockwood III级损伤的患者可能存在不同程度的肩锁关节水平不稳定。
对18例连续发生肩锁关节脱位且归类为Rockwood III型的患者进行放射学评估，以量化肩锁关节的水平不稳定情况。具体的放射学检查包括外侧应力X线片（Alexander位）以及患侧手臂处于水平内收位时的轴向应力X线片。
发现肩锁关节的动态水平不稳定与Rockwood分类中测量的垂直脱位无关。
对于进一步的治疗研究，应区分存在或不存在明显肩锁关节水平不稳定的Rockwood III型损伤患者。
