Eschler Anica, Rösler Klaus, Rotter Robert, Gradl Georg, Mittlmeier Thomas, Gierer Philip
Department of Trauma, Hand and Reconstructive Surgery, Medical Center, University of Rostock, Schillingallee 35, 18057, Rostock, Germany,
Arch Orthop Trauma Surg. 2014 Sep;134(9):1193-8. doi: 10.1007/s00402-014-2045-1. Epub 2014 Jul 4.
The classification system of Rockwood and Young is a commonly used classification for acromioclavicular joint separations subdividing types I-VI. This classification hypothesizes specific lesions to anatomical structures (acromioclavicular and coracoclavicular ligaments, capsule, attached muscles) leading to the injury. In recent literature, our understanding for anatomical correlates leading to the radiological-based Rockwood classification is questioned. The goal of this experimental-based investigation was to approve the correlation between the anatomical injury pattern and the Rockwood classification.
In four human cadavers (seven shoulders), the acromioclavicular and coracoclavicular ligaments were transected stepwise. Radiological correlates were recorded (Zanca view) with 15-kg longitudinal tension applied at the wrist. The resulting acromio- and coracoclavicular distances were measured.
Radiographs after acromioclavicular ligament transection showed joint space enlargement (8.6 ± 0.3 vs. 3.1 ± 0.5 mm, p < 0.05) and no significant change in coracoclavicular distance (10.4 ± 0.9 vs. 10.0 ± 0.8 mm). According to the Rockwood classification only type I and II lesions occurred. After additional coracoclavicular ligament cut, the acromioclavicular joint space width increased to 16.7 ± 2.7 vs. 8.6 ± 0.3 mm, p < 0.05. The mean coracoclavicular distance increased to 20.6 ± 2.1 mm resulting in type III-V lesions concerning the Rockwood classification.
Trauma with intact coracoclavicular ligaments did not result in acromioclavicular joint lesions higher than Rockwood type I and II. The clinical consequence for reconstruction of low-grade injuries might be a solely surgical approach for the acromioclavicular ligaments or conservative treatment. High-grade injuries were always based on additional structural damage to the coracoclavicular ligaments. Rockwood type V lesions occurred while muscle attachments were intact.
Rockwood和Young分类系统是肩锁关节分离常用的分类方法，将其分为I - VI型。该分类假设特定的解剖结构（肩锁韧带、喙锁韧带、关节囊、附着肌肉）损伤导致了损伤。在最近的文献中，我们对基于影像学的Rockwood分类的解剖学关联的理解受到了质疑。本基于实验的研究目的是证实解剖损伤模式与Rockwood分类之间的相关性。
在四具人体尸体（七个肩部）上，逐步切断肩锁韧带和喙锁韧带。在手腕处施加15千克纵向拉力时记录影像学关联（Zanca位片）。测量由此产生的肩锁和喙锁间距。
切断肩锁韧带后的X线片显示关节间隙增大（8.6±0.3对3.1±0.5毫米，p<0.05），喙锁间距无显著变化（10.4±0.9对10.0±0.8毫米）。根据Rockwood分类，仅出现I型和II型损伤。额外切断喙锁韧带后，肩锁关节间隙宽度增加至16.7±2.7对8.6±0.3毫米，p<0.05。平均喙锁间距增加至20.6±2.1毫米，导致Rockwood分类中的III - V型损伤。
喙锁韧带完整的创伤不会导致高于Rockwood I型和II型的肩锁关节损伤。对于低度损伤重建的临床后果可能是仅对肩锁韧带进行手术治疗或保守治疗。高度损伤总是基于喙锁韧带的额外结构损伤。在肌肉附着完整的情况下出现了Rockwood V型损伤。
