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[胸锁关节损伤]

[Injuries of the sternoclavicular joint].

作者信息

Dey Hazra Rony-Orijit, Reich Anne-Rieke, Hanhoff Marek, Warnhoff Mara, Lill Helmut, Jensen Gunnar

机构信息

Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift Hannover, Humboldstr. 5, 30169, Hannover, Deutschland.

出版信息

Unfallchirurg. 2020 Nov;123(11):879-889. doi: 10.1007/s00113-020-00888-2.

Abstract

Injuries of the sternoclavicular joint (SCJ) are rare accounting for 3% of all injuries to the shoulder girdle and are often overlooked. The SCJ is surrounded by tight ligamentous structures, thus substantial energy with corresponding force vectors is needed to cause dislocation. Causative are mostly high-energy traumas. Anterior dislocation is most common but in rare cases potentially life-threatening posterior dislocation occurs, which requires immediate reduction. The established gold standard is 3D reconstruction in contrast-enhanced computed tomography (CT) for depiction of neurovascular structures. Low-grade instability can initially be treated conservatively. For unsuccessful attempts at reduction, high-grade instability and chronic instability various surgical techniques are established. Next to retentive augmentation with suture materials, in acute cases with chronic instability biological tendon augmentation is preferred. In cases of posttraumatic instability arthritis SCJ resection with or without additive biological augmentation can be carried out. Various study groups have shown good to very good midterm outcome.

摘要

胸锁关节(SCJ)损伤较为罕见,占肩胛带所有损伤的3%,且常被忽视。胸锁关节被紧密的韧带结构所环绕,因此需要相当大的能量及相应的力向量才能导致脱位。其病因多为高能量创伤。前脱位最为常见,但在罕见情况下会发生潜在危及生命的后脱位,这需要立即复位。既定的金标准是在对比增强计算机断层扫描(CT)中进行三维重建,以描绘神经血管结构。低度不稳定最初可采用保守治疗。对于复位失败、高度不稳定和慢性不稳定的情况,已确立了各种手术技术。除了用缝合材料进行保留性增强外,在慢性不稳定的急性病例中,生物肌腱增强更为可取。在创伤后不稳定关节炎的病例中,可进行胸锁关节切除,可加用或不加用生物增强。多个研究组已表明中期效果良好至极佳。

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