Vetter Philipp, Frege Sophie, Paksoy Alp, Akgün Doruk, Scheibel Markus, Moroder Philipp
Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland.
BG Clinic, Trauma Hospital Berlin, Berlin, Germany.
JSES Int. 2025 Feb 11;9(3):646-650. doi: 10.1016/j.jseint.2025.01.012. eCollection 2025 May.
Acromioclavicular joint (ACJ) dislocations have been linked to altered scapulothoracic orientation and scapula dyskinesis, but research on three-dimensional (3D) changes in scapulothoracic orientation after such injury in vivo has not been described before. The aim of our pilot study was to analyze scapulothoracic orientation changes in patients with ACJ dislocations using three-dimensional computed tomographic (CT) image reconstruction.
Patients with ACJ dislocations who underwent CT imaging were included retrospectively and consecutively. Minors and cases with spine, neurologic or systemic diseases, and shoulder girdle fractures were excluded. Each CT was performed in supine position with elbows rested on the scanning table and had to depict the complete shoulder girdle. After 3D image reconstruction, tilt, upward rotation, internal rotation, translation, and protraction of the scapula were measured based on three osseous landmarks: the glenoid (the deepest point of its concavity), the medial root of the scapular spine, and the inferior scapular angle. The healthy contralateral side was used as a paired control. ACJ dislocations were graded according to Rockwood (RW) on strict frontal CT image reconstruction, including the contralateral shoulder, where measurements were also performed to enable comparison. Cases were labeled as acute or chronic with a 3-week injury-to-diagnosis interval cut-off.
The mean age of the 14 patients (11 males and 3 females) was 38.6 ± 15.6 years (range, 18-71). Ten cases were defined as acute (RW types II: 1; III: 3; V: 6) and four as chronic (II: 1; III: 2; V: 1). On the injured side, the scapula showed more internal rotation (46.2° ± 5.3° vs. 42.1° ± 4.4°; = .003), more scapular tilt (20.2° ± 4.6° vs. 17.9° ± 3.5°; = .022), and less upward rotation (10.1° ± 3.6° vs. 12.0° ± 4.8°; = .043). No difference between sides was found for scapular translation ( = .342) and scapular protraction ( = .385). There was a trend toward more internal rotation for RW type V injuries ( = .097).
In this first 3D in vivo study, patients with ACJ dislocations displayed changes in scapulothoracic orientation in all planes. The scapula of the injured side was more internally rotated, forwardly tilted, and less upwardly rotated than on the healthy contralateral side.
肩锁关节（ACJ）脱位与肩胛胸壁方向改变和肩胛骨运动障碍有关，但此前尚未有关于此类损伤后体内肩胛胸壁方向三维（3D）变化的研究报道。我们的初步研究旨在使用三维计算机断层扫描（CT）图像重建分析ACJ脱位患者的肩胛胸壁方向变化。
回顾性连续纳入接受CT成像的ACJ脱位患者。排除未成年人以及患有脊柱、神经或全身性疾病和肩胛带骨折的病例。每次CT检查均在仰卧位进行，肘部置于扫描台上，且必须显示完整的肩胛带。在进行3D图像重建后，基于三个骨性标志测量肩胛骨的倾斜、上旋、内旋、平移和前伸：肩胛盂（其凹面的最深点）、肩胛冈内侧根部和肩胛骨下角。以对侧健康侧作为配对对照。在严格的正位CT图像重建上根据Rockwood（RW）对ACJ脱位进行分级，包括对侧肩部，也在对侧肩部进行测量以进行比较。病例根据损伤至诊断间隔3周的界限分为急性或慢性。
14例患者（11例男性和3例女性）的平均年龄为38.6±15.6岁（范围18 - 71岁）。10例定义为急性（RW II型：1例；III型：3例；V型：6例），4例为慢性（II型：1例；III型：2例；V型：1例）。在患侧，肩胛骨显示出更多的内旋（46.2°±5.3°对42.1°±4.4°；P = 0.003）、更多的肩胛骨倾斜（20.2°±4.6°对17.9°±3.5°；P = 0.022）和更少的上旋（10.1°±3.6°对12.0°±4.8°；P = 0.043）。肩胛骨平移（P = 0.342）和肩胛骨前伸（P = 0.385）两侧之间未发现差异。RW V型损伤有内旋增加的趋势（P = 0.097）。
在这项首次三维体内研究中，ACJ脱位患者在所有平面上均显示出肩胛胸壁方向的变化。患侧肩胛骨比健康对侧肩胛骨内旋更多、前倾更多且上旋更少。
