Van Tongel Alexander, Valcke Jens, Piepers Iwein, Verschueren Thomas, De Wilde Lieven
Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. E-mail address for A. Van Tongel:
J Bone Joint Surg Am. 2014 Jul 2;96(13):e109. doi: 10.2106/JBJS.M.00623.
Clavicular prominence is common in patients with symptomatic degenerative sternoclavicular arthritis. It is unclear if this is caused by enlargement or subluxation of the clavicle. The aim of this report is to describe a reproducible measurement technique to evaluate the relationship of the medial clavicular head to the manubrium.
One hundred normal sternoclavicular joints, twenty-five sternoclavicular joints with symptomatic degenerative arthritis, and twenty-five non-symptomatic sternoclavicular joints on the contralateral side were studied with three-dimensional (3D) reconstruction with use of computer modeling. The greatest width (anterior-posterior distance) and height (superior-inferior distance) of the clavicle in the sagittal plane were measured, and the positions of the anterior and superior borders of the medial clavicle and their distances to the frontal and axial planes, respectively, were evaluated. The ratio of the anterior-posterior distance to the anterior-frontal plane distance was measured to evaluate the anterior-posterior position of the clavicle and the ratio of the superior-inferior distance to the superior-axial plane distance was measured to evaluate its superoinferior position. If the ratio was not in the 95% normal range, the clavicle was defined as subluxated. The reproducibility of this technique was evaluated on the basis of the interobserver and intraobserver reliability.
This technique showed good interobserver and intraobserver reliability. The mean anterior-posterior and superior-inferior distances were significantly larger in association with symptomatic sternoclavicular arthritis than in the normal sternoclavicular joints (p < 0001). The clavicle was subluxated anteriorly in twenty-two of the twenty-five cases of symptomatic sternoclavicular arthritis, but it was not subluxated superiorly.
The medial clavicular head in patients with degenerative sternoclavicular arthritis is significantly larger than it is in the normal population, and it is usually subluxated anteriorly.
锁骨突出在有症状的退行性胸锁关节炎患者中很常见。尚不清楚这是由锁骨增大还是半脱位引起的。本报告的目的是描述一种可重复的测量技术，以评估锁骨内侧头与胸骨柄的关系。
使用计算机建模对100个正常胸锁关节、25个有症状的退行性关节炎胸锁关节以及对侧25个无症状胸锁关节进行三维（3D）重建研究。测量锁骨在矢状面的最大宽度（前后距离）和高度（上下距离），并评估锁骨内侧的前后边界位置及其与额面和轴面的距离。测量前后距离与额面距离的比值以评估锁骨的前后位置，测量上下距离与轴面距离的比值以评估其上下位置。如果该比值不在95%正常范围内，则将锁骨定义为半脱位。基于观察者间和观察者内的可靠性评估该技术的可重复性。
该技术显示出良好的观察者间和观察者内可靠性。与有症状的胸锁关节炎相关的平均前后距离和上下距离显著大于正常胸锁关节（p<0.001）。25例有症状的胸锁关节炎患者中，有22例锁骨向前半脱位，但未向上半脱位。
退行性胸锁关节炎患者的锁骨内侧头明显大于正常人群中的，且通常向前半脱位。
