肩锁关节急性脱位的诊断与治疗。
The Diagnosis and Treatment of Acute Dislocation of the Acromioclavicular Joint.
机构信息
German Center of Shoulder Surgery, ATOS Clinic Munich, Department of Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany; Upper Extremity Department, Schulthess Clinic Zurich; Center for Musculoskeletal Surgery (CMSC), Charité-University Medicine Berlin, Berlin, Germany; Department of Orthopedic Surgery, Alfried Krupp Hospital Essen, Essen, Germany; Department of Sports Orthopedics, Marienkrankenhaus Kaiserswerth, Düsseldorf, Germany; Department of Orthopedics and Trauma Surgery, University Hospital Freiburg, Freiburg, Germany; The authors are members of the Shoulder Committee of the German Society of Arthroscopy and Joint Surgery (AGA, Deutsche Gesellschaft für Arthroskopie und Gelenkchirurgie).
出版信息
Dtsch Arztebl Int. 2019 Feb 8;116(6):89-95. doi: 10.3238/arztebl.2019.0089.
BACKGROUND
The acromioclavicular joint (ACJ) is one of the more common sites of shoulder girdle injury, accounting for 4-12% of all such injuries, with an incidence of 3-4 cases per 100 000 persons per year in the general population. Current topics of debate include the proper standard diagnostic evaluation, the indications for surgery, and the best operative method.
METHODS
This review is based on publications retrieved by a selective literature search.
RESULTS
Mechanical trauma of the ACG can tear the ligamentous apparatus that holds the acromion, clavicle, and coracoid process together. Different interventions are indicated depending on the nature of the injury. In recent years, the horizontal component of the instability has received more attention, in addition to its vertical component. Persistent instability can lead to chronic, painful limitation of shoulder function, particularly with respect to working above the head. Surgical stabilization is therefore recommended for high-grade instability of Rockwood types IV and V. Modern reconstruction techniques enable selective vertical and horizontal treatment of the instability and have been found superior to traditional methods, particularly in young athletes. Arthroscopic techniques are advantageous because they are less invasive, do not require removal of implanted material, and afford the opportunity to diagnose any accompanying lesions definitively and to treat them if necessary. Surgery for acute injuries should be performed within three weeks of the trauma. For chronic injuries, additional tendon augmentation is now considered standard treatment.
CONCLUSION
High-grade ACJ instability is a complex and significant injury of the shoulder girdle that can cause persistent pain and functional impairment. The state of the evidence regarding its optimal treatment is weak. Large-scale, prospective, randomized comparative studies are needed in order to define a clear standard of treatment.
背景
肩锁关节（ACJ）是肩部常见的损伤部位之一，占所有此类损伤的 4-12%，在普通人群中每年每 100000 人中发生 3-4 例。目前争议的话题包括适当的标准诊断评估、手术指征和最佳手术方法。
方法
本综述基于通过选择性文献检索检索到的出版物。
结果
ACG 的机械创伤会撕裂将肩峰、锁骨和喙突固定在一起的韧带装置。根据损伤的性质，需要进行不同的干预。近年来，除了垂直成分外，对不稳定的水平成分的关注也越来越多。持续的不稳定可能导致慢性、疼痛性肩部功能受限，尤其是在头顶上方工作时。因此，建议对 Rockwood 类型 IV 和 V 的高等级不稳定进行手术稳定。现代重建技术能够选择性地治疗垂直和水平不稳定，并且已经被发现优于传统方法，尤其是在年轻运动员中。关节镜技术具有优势，因为它们的侵入性较小，不需要取出植入物，并且有机会明确诊断任何伴随的病变并在必要时进行治疗。对于急性损伤，手术应在创伤后 3 周内进行。对于慢性损伤，现在认为额外的肌腱增强是标准治疗。
结论
高等级 ACJ 不稳定是肩部复杂而严重的损伤，可导致持续疼痛和功能障碍。关于其最佳治疗的证据状态较弱。需要进行大规模、前瞻性、随机对照研究，以确定明确的治疗标准。
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