Tepolt Frances, Carry Patrick M, Heyn Patricia C, Miller Nancy H
University of Colorado, Denver, Colorado, USA.
Children's Hospital Colorado, Aurora, Colorado, USA.
Am J Sports Med. 2014 Oct;42(10):2517-24. doi: 10.1177/0363546514523386. Epub 2014 Feb 25.
Sternoclavicular dislocations are relatively infrequent and are generally divided into anterior and posterior disruptions, the former being the most common. While posterior sternoclavicular joint (PSCJ) injuries are very rare, they may be associated with life-threatening complications. The ideal management of these injuries, particularly in the adolescent population, has not been well described.
Through a meta-analysis of PSCJ injuries in the adolescent, we aimed to (1) describe the epidemiology of PSCJ injuries in relation to the mechanism of injury, associated complications, and treatment preferences; (2) compare the success of closed reduction when attempted <48 versus >48 hours after the initial injury; and (3) compare the outcomes of closed versus open treatment.
Meta-analysis.
A thorough review of the English literature was performed to identify all cases of PSCJ dislocations or medial clavicular physeal fractures in patients aged 12 to 18 years. Patient-level data for 140 patients were extracted from 79 studies.
The mean age of the patients was 15.24 years. Forty-nine patients (35.00%) underwent closed treatment only, 42 (30.00%) open treatment alone, and 47 (33.57%) closed treatment followed by open treatment. Also, 55.8% of closed reductions performed within 48 hours were successful compared with 30.8% of those performed more than 48 hours after injury. After initial treatment, 92.31% of patients treated with closed reduction regained full function without recurrence as compared with 95.83% of patients treated operatively.
Closed and open methods have proven highly effective for the treatment of PSCJ injuries. However, follow-up data reported in the literature vary considerably. Closed reduction is most effective when attempted less than 48 hours after the initial injury.
胸锁关节脱位相对少见，通常分为前脱位和后脱位，前者最为常见。虽然胸锁关节后脱位（PSCJ）非常罕见，但可能伴有危及生命的并发症。这些损伤的理想治疗方法，尤其是在青少年人群中，尚未得到充分描述。
通过对青少年PSCJ损伤的荟萃分析，我们旨在（1）描述PSCJ损伤的流行病学，包括损伤机制、相关并发症和治疗偏好；（2）比较初次损伤后<48小时与>48小时尝试闭合复位的成功率；（3）比较闭合治疗与开放治疗的结果。
荟萃分析。
对英文文献进行全面回顾，以确定12至18岁患者中所有PSCJ脱位或锁骨内侧骨骺骨折的病例。从79项研究中提取了140例患者的个体水平数据。
患者的平均年龄为15.24岁。49例患者（35.00%）仅接受了闭合治疗，42例（30.00%）仅接受了开放治疗，47例（33.57%）先接受了闭合治疗，随后接受了开放治疗。此外，伤后48小时内进行的闭合复位中有55.8%成功，而伤后超过48小时进行的闭合复位成功率为30.8%。初始治疗后，闭合复位治疗的患者中有92.31%恢复了全部功能且无复发，而手术治疗的患者这一比例为95.83%。
闭合和开放方法已被证明对治疗PSCJ损伤非常有效。然而，文献报道的随访数据差异很大。初次损伤后不到48小时尝试闭合复位最为有效。
