Schmitt Sebastian, Magosch Petra, Habermeyer Peter, Lichtenberg Sven
Schulter- und Ellenbogenchirurgie, Deutsches Gelenkzentrum Heidelberg, ATOS Klinik Heidelberg, Bismarckstraße 9-15, 69115, Heidelberg, Deutschland.
Unfallchirurg. 2017 Sep;120(9):795-803. doi: 10.1007/s00113-017-0384-4.
Bipolar dislocation of the clavicle is rare. In the literature, every reported bipolar dislocation of the clavicle is caused by a traumatic injury with loss of function of the affected shoulder. Currently, there is no recommendation to treat. A conservative treatment can be tried first to achieve adequate shoulder function. If this cannot be achieved, surgical treatment will be indicated. In the literature, many options for surgical treatment are described. This article presents a case of a chronic Rockwood V injury with chronic anterior sternoclavicular joint instability. The special feature of this case was the arthroscopically assisted stabilization of the acromioclavicular joint (ACJ) with the ipsilateral semitendinosus tendon graft and the open stabilization of the sternoclavicular joint (SCJ) with the ipsilateral gracilis tendon graft. A lateral fracture of the clavicle in the course of the postoperative treatment was treated with a plate osteosynthesis. At follow-up after six months, the postoperative shoulder function was restored. The ACJ and the SCJ were stable in clinical and radiographic examination. This case report shows the first surgical treatment using two tendon grafts for combined stabilization of the ACJ and SCJ.
锁骨双极脱位很少见。在文献中，每例报道的锁骨双极脱位均由创伤性损伤导致患侧肩部功能丧失引起。目前，尚无治疗建议。可先尝试保守治疗以获得足够的肩部功能。若无法实现，则需进行手术治疗。文献中描述了多种手术治疗方案。本文介绍了一例慢性Rockwood V型损伤伴慢性胸锁关节不稳的病例。该病例的特殊之处在于通过关节镜辅助使用同侧半腱肌腱移植对肩锁关节（ACJ）进行稳定，并通过开放手术使用同侧股薄肌腱移植对胸锁关节（SCJ）进行稳定。术后治疗过程中锁骨外侧骨折采用钢板内固定治疗。术后六个月随访时，肩部功能恢复。临床及影像学检查显示ACJ和SCJ稳定。本病例报告展示了首例使用两根肌腱移植联合稳定ACJ和SCJ的手术治疗。
