Minkus Marvin, Hann Carmen, Scheibel Markus, Kraus Natascha
Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
Arch Orthop Trauma Surg. 2017 Jun;137(6):845-852. doi: 10.1007/s00402-017-2691-1. Epub 2017 Apr 17.
Classification of AC-joint instability is based on radiologic evaluation of anteroposterior (a.p.) stress views of both shoulders, neglecting the horizontal component of instability. Recent studies have proposed an association of dynamic posterior translation (DPT) and inferior clinical results. The purpose of this study was to quantify DPT in modified Alexander views and correlate it with other radiological and clinical data.
Thirty-two patients (4 f, 28 m, mean age 34.1) with acute AC-joint dislocation (16 = RW III, 16 = RW V) underwent radiological examination including bilateral a.p. stress views with measurement of the coracoclavicular distance (CCD) and bilateral modified Alexander views with different approaches to quantify DPT (overlapping area OA, overlapping length OL). In addition, the Constant Score, Subjective Shoulder Value, Taft Score (TF), and the Acromioclavicular Joint Instability Score (ACJI) were obtained.
In Rockwood (RW) type III injuries, a mean CCD of 15.8 (9.8-22.8) mm, OA of 50.9 (0-216.6) mm, and OL of 6.5 (-4.7-17.9) mm were found. RW V patients showed a CCD of 23.1 (13.7-32.0) mm; OA 7.0 (0-92.3) mm; and OL -4.8 (-19.6-9.8) mm. Particularly in RW III the CCD, OA and OL revealed significant correlation with the ACJI (r = -0.64/r = 0.72/r = 0.68, p < 0.05) and TF (r = -0.56/r = 0.68/r = 0.51, p < 0.05). The proposed quantification tools for DPT were found to have a moderate-to-strong correlation with the score results, especially with AC-joint specific scores. RW type V injuries had a moderate correlation with clinical parameters (OA with ACJI: r = 0.44, p > 0.05 and OL with TF: r = -0.45, p > 0.05).
Measuring the OL is a convenient way for quantifying DPT in modified Alexander views. It showed significant correlation with clinical scores, indicating the relevance of DPT in patients with AC-joint injury.
肩锁关节不稳定的分类基于双肩前后位应力视图的放射学评估，而忽略了不稳定的水平分量。最近的研究提出动态后向平移（DPT）与较差的临床结果相关。本研究的目的是在改良亚历山大视图中量化DPT，并将其与其他放射学和临床数据相关联。
32例急性肩锁关节脱位患者（4例女性，28例男性，平均年龄34.1岁）（16例为Rockwood III型，16例为Rockwood V型）接受了放射学检查，包括双侧前后位应力视图以测量喙锁距离（CCD），以及双侧改良亚历山大视图，采用不同方法量化DPT（重叠面积OA、重叠长度OL）。此外，还获得了Constant评分、主观肩关节评分、Taft评分（TF）和肩锁关节不稳定评分（ACJI）。
在Rockwood（RW）III型损伤中，平均CCD为15.8（9.8 - 22.8）mm，OA为50.9（0 - 216.6）mm，OL为6.5（ - 4.7 - 17.9）mm。RW V型患者的CCD为23.1（13.7 - 32.0）mm；OA为7.0（0 - 92.3）mm；OL为 - 4.8（ - 19.6 - 9.8）mm。特别是在RW III型中，CCD、OA和OL与ACJI（r = - 0.64/r = 0.72/r = 0.68，p < 0.05）和TF（r = - 0.56/r = 0.68/r = 0.51，p < 0.05）显示出显著相关性。发现所提出的DPT量化工具与评分结果具有中度至强相关性，尤其是与肩锁关节特异性评分。RW V型损伤与临床参数具有中度相关性（OA与ACJI：r = 0.44，p > 0.05；OL与TF：r = - 0.45，p > 0.05）。
测量OL是在改良亚历山大视图中量化DPT的便捷方法。它与临床评分显示出显著相关性，表明DPT在肩锁关节损伤患者中的相关性。
