Kibler W Ben, Sciascia Aaron
Shoulder Center of Kentucky, Lexington Clinic, Lexington, KY, USA.
Institute of Clinical Outcomes and Research, Lexington Clinic, Lexington, KY, USA.
Shoulder Elbow. 2022 Oct;14(5):470-480. doi: 10.1177/17585732221122335. Epub 2022 Sep 1.
Multiple papers have described aspects of treatment of acromioclavicular (AC) joint injuries. Most have emphasized aspects of surgical treatment, and some papers have addressed non-operative treatment. Few papers have highlighted the specific pathoanatomy of an AC joint injury or have described methods of evaluating the 3-dimensional pathomechanics resulting from the pathoanatomical injury. This paper is based on 3 observations: (1) AC joint injuries exist and present on a spectrum of pathoanatomy; (2) The effect of the pathoanatomy on normal AC joint mechanics to produce pathomechanics is dependent on the extent of the pathoanatomy; and (3) Treatment protocols should be developed to address the specific pathoanatomy to optimize the mechanics. A comprehensive clinical approach emphasizing the evaluation of the extent of the anatomic injury and understanding its mechanical consequences regarding shoulder and arm function is a key in the development of guidelines for developing operative or non-operative treatment protocols and for establishing outcomes of the treatment protocols.
多篇论文描述了肩锁关节（AC）损伤的治疗方面。大多数论文强调了手术治疗的方面，一些论文讨论了非手术治疗。很少有论文突出AC关节损伤的具体病理解剖结构，或描述评估由病理解剖损伤导致的三维病理力学的方法。本文基于三点观察：（1）AC关节损伤存在且呈现出一系列病理解剖结构；（2）病理解剖结构对正常AC关节力学产生病理力学的影响取决于病理解剖结构的程度；（3）应制定治疗方案以应对特定的病理解剖结构，从而优化力学。一种全面的临床方法，强调评估解剖损伤的程度并理解其对肩部和手臂功能的力学后果，是制定手术或非手术治疗方案指南以及确定治疗方案结果的关键。
