Scientific, Organization and Methodology Department, SI "Institute of Traumatology and Orthopedics of the NAMS of Ukraine", Kyiv, Ukraine.
Functional Diagnostics Department SI "Institute of Traumatology and Orthopedics of the NAMS of Ukraine," Kyiv, Ukraine.
Ortop Traumatol Rehabil. 2022 Feb 28;24(1):1-12. doi: 10.5604/01.3001.0015.7800.
The aim was to improve the diagnosis of acromioclavicular joint dislocation by studying the capabilities and characteristics of clinical and instrumental diagnostic methods. The idea is expressed that modern clinical and instrumental diagnostic methods comprise a large number of techniques, but no single algorithm for diagnosing injury to the AC joint has been developed. A gold standard for investigating and diagnosing acute AC joint dislocation does not currently exist.
A retrospective study of the characteristics and capabilities of clinical and instrumental diagnostic methods was performed in 152 patients with traumatic shoulder pathology. The patients were divided into two groups: Group I of 102 patients (67%) with acromioclavicular joint dislocation type III-VI according to Rockwood classification and Group II of 50 patients (33%) with a partial tear of the rotator cuff. Clinical and instrumental examinations involved specific provocative tests; the radiological diagnostics comprised conventional radiographs with the Zanca, axillary and Alexander views, and CT, MRI, and ultrasound examinations.
The characterization of examination methods was based on the records of patients in Group I and II. The most sensitive clinical test to establish Rockwood type V of acromioclavicular joint dislocation was the Paxinos test (91%). The lowest sensitivity across the tests used was observed with the active compression test to diagnose type IV of dislocation (50%). As regards the X-ray examination, the axial view was 100% sensitive for detecting type IV and VI AC joint dislocation. The Zanca view is highly sensitive for patients with Rockwood type V and Alexander view for Rockwood type III and V dislocations. The accuracy of ultrasound work-up in Group I was 95%, with 96% sensitivity and 93% specificity, while MRI accuracy was 97%, with 96% sensitivity and 98% specificity, and CT accuracy was 81%, with 83% sensitivity and 75% specificity.
本研究旨在通过研究临床和仪器诊断方法的能力和特点，提高对肩锁关节脱位的诊断水平。目前认为，现代临床和仪器诊断方法包括许多技术，但尚未开发出诊断肩锁关节损伤的单一算法。目前，尚无调查和诊断急性肩锁关节脱位的金标准。
对 152 例创伤性肩部病变患者的临床和仪器诊断方法的特点和能力进行回顾性研究。患者分为两组：第 I 组 102 例（67%）为 Rockwood 分类的 III-VI 型肩锁关节脱位，第 II 组 50 例（33%）为肩袖部分撕裂。临床和仪器检查包括特定的激发试验；放射学诊断包括常规 X 线片（Zanca 位、腋位和 Alexander 位）、CT、MRI 和超声检查。
基于第 I 组和第 II 组患者的记录对检查方法进行了特征描述。最敏感的临床试验是用于诊断 Rockwood 型 V 肩锁关节脱位的 Paxinos 试验（91%）。在使用的所有试验中，主动压缩试验诊断 IV 型脱位的敏感性最低（50%）。在 X 线检查方面，轴位视图对检测 IV 型和 VI 型肩锁关节脱位的敏感性为 100%。Zanca 位视图对 Rockwood 型 V 患者高度敏感，Alexander 位视图对 Rockwood 型 III 和 V 型脱位高度敏感。第 I 组中超声检查的准确性为 95%，敏感性为 96%，特异性为 93%，MRI 的准确性为 97%，敏感性为 96%，特异性为 98%，CT 的准确性为 81%，敏感性为 83%，特异性为 75%。
