Takase Katsumi, Hata Yukihiko, Morisawa Yutaka, Goto Masafumi, Tanaka Sakae, Hamada Junichiro, Hayashida Kenji, Fujii Yasunari, Morihara Toru, Yamamoto Nobuyuki, Inui Hiroaki, Shiozaki Hiroyuki
Scientific Research Project Committee of the Japan Shoulder Society, Tokyo, Japan.
JSES Int. 2020 Feb 13;4(2):242-245. doi: 10.1016/j.jseint.2019.11.006. eCollection 2020 Jun.
In acromioclavicular joint (ACJ) separations, patient characteristics determine the indications for surgery. However, in Japan, classification methods used to assess the severity of ACJ separations differ between institutions, and even within a classification method, different interpretations can lead to different assessments of severity. Therefore, in this study, we conducted an email survey of Japan Shoulder Society (JSS) members regarding their assessment methods for ACJ separation severity.
A questionnaire about methods for assessing the severity of ACJ separations was emailed to JSS members (1655) including 59 JSS councilors. The survey focused on diagnostic imaging methods, classifications of severity assessments, and methods of assessing severity.
In total, 183 responses were received. All respondents used an anteroposterior view of the ACJ. Severity assessments were classified by the Tossy classification (57 respondents), Rockwood classification (141 respondents), and other classifications (7 respondents) including duplication. Of the 141 respondents using the Rockwood classification, 119 diagnosed type III as ACJ dislocation when the inferior clavicle border translated above the superior acromial border, whereas 56 used the coracoclavicular distance. However, to diagnose type V, 118 respondents used the coracoclavicular distance whereas 38 used palpation. To diagnose type IV, 57 respondents considered all cases in which the clavicle translated posterior to the acromion, even when vertical ACJ dislocation occurred simultaneously. However, 88 respondents did so in the presence of posterior clavicle displacement and ACJ subluxation.
The Rockwood classification is commonly used for severity assessments in Japan; however, there is some disagreement regarding the assessment for the diagnosis of type IV. Methods to diagnose both superior and posterior translation of the clavicle need further debate.
在肩锁关节（ACJ）分离中，患者特征决定手术指征。然而，在日本，不同机构用于评估ACJ分离严重程度的分类方法存在差异，而且即使在一种分类方法内，不同的解读也可能导致对严重程度的不同评估。因此，在本研究中，我们就肩锁关节分离严重程度的评估方法对日本肩肘外科协会（JSS）成员进行了电子邮件调查。
向包括59名JSS议员在内的1655名JSS成员发送了一份关于肩锁关节分离严重程度评估方法的问卷。调查重点关注诊断成像方法、严重程度评估分类以及评估严重程度的方法。
共收到183份回复。所有受访者均使用了肩锁关节的前后位视图。严重程度评估按Tossy分类（57名受访者）、Rockwood分类（141名受访者）以及包括重复分类在内的其他分类（7名受访者）进行。在使用Rockwood分类的141名受访者中，当锁骨下边缘平移至肩峰上边缘上方时，119人将III型诊断为肩锁关节脱位，而56人使用喙锁间距。然而，对于V型诊断，118名受访者使用喙锁间距，而38人使用触诊。对于IV型诊断，57名受访者认为所有锁骨平移至肩峰后方的病例均为IV型，即使同时发生垂直方向的肩锁关节脱位。然而，88名受访者在存在锁骨后移位和肩锁关节半脱位时才如此诊断。
在日本，Rockwood分类常用于严重程度评估；然而，对于IV型诊断的评估存在一些分歧。锁骨向上和向后平移的诊断方法需要进一步探讨。
