肩锁关节脱位的治疗进展
摘要
肩锁关节脱位约占所有肩关节损伤的9%,可引起肩关节疼痛和活动障碍,严重影响患者生活质量和运动能力。近年,随着内固定物及相关生物力学研究的快速发展,肩锁关节脱位的手术治疗正逐步优化改进,手术方式可分为解剖固定和非解剖固定。非解剖固定并发症较多,且需进行再次手术取出内固定物;解剖固定能使肩锁关节更接近原本生物力学状态,术后患者满意度较高。另外,关节镜技术的普及推动了肩锁关节微创治疗。该文就肩锁关节解剖形态、肩锁关节脱位损伤分型及治疗方法等作一综述。
引文
[1]Mazzocca AD,Arciero RA,Bicos J.Evaluation and treatment of acromioclavicular joint injuries[J].Am J Sports Med,2007,35(2):316-329.
[2]Zhu NF,Rui BY,Zhang YL,et al.Anatomic study of coracoclavicular ligaments for reconstruction of acromioclavicular joint dislocations[J].J Orthop Sci,2016,21(6):749-752.
[3]Gorbaty JD,Hsu JE,Gee AO.Classifications in brief:Rockwood classification of acromioclavicular joint separations[J].Clin Orthop Relat Res,2017,475(1):283-287.
[4]Maier D,Jaeger M,Reising K,et al.Injury patterns of the acromioclavicular ligament complex in acute acromioclavicular joint dislocations:a cross-sectional,fundamental study[J].BMC Musculoskelet Disord,2016,17(1):385.
[5]Pauly S,Kraus N,Greiner S,et al.Prevalence and pattern of glenohumeral injuries among acute high-grade acromioclavicular joint instabilities[J].J Shoulder Elbow Surg,2013,22(6):760-766.
[6]Murena L,Canton G,Vulcano E,et al.Scapular dyskinesis and SICK scapula syndrome following surgical treatment of typeⅢacute acromioclavicular dislocations[J].Knee Surg Sports Traumatol Arthrosc,2013,21(5):1146-1150.
[7]Longo UG,Ciuffreda M,Rizzello GA,et al.Surgical versus conservative management of typeⅢacromioclavicular dislocation:a systematic review[J].Br Med Bull,2017,122(1):31-49.
[8]Beitzel K,Mazzocca AD,Bak K,et al.ISAKOS upper extremity committee consensus statement on the need for diversification of the Rockwood classification for acromioclavicular joint injuries[J].Arthroscopy,2014,30(2):271-278.
[9]Carbone S,Postacchini R,Gumina S.Scapular dyskinesis and SICK syndrome in patients with a chronic typeⅢacromioclavicular dislocation.Results of rehabilitation[J].Knee Surg Sports Traumatol Arthrosc,2015,23(5):1473-1480.
[10]Jensen G,Katthagen JC,Alvarado LE,et al.Has the arthroscopically assisted reduction of acute AC joint separations with the double tight-rope technique advantages over the clavicular hook plate fixation?[J].Knee Surg Sports Traumatol Arthrosc,2014,22(2):422-430.
[11]Debski RE,Parsons IM 4th,Woo SL,et al.Effect of capsular injury on acromioclavicular joint mechanics[J].J Bone Joint Surg Am,2001,83A(9):1344-1351.
[12]Wellmann M,da Silva G,Lichtenberg S,et al.Instability pattern of acromioclavicular joint dislocations type RockwoodⅢ:relevance of horizontal instability[J].Orthopade,2013,42(4):271-277.
[13]Scheibel M,Dr9schel S,Gerhardt C,et al.Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations[J].Am J Sports Med,2011,39(7):1507-1516.
[14]Weinstein DM,Mccann PD,Mcilveen SJ,et al.Surgical treatment of complete acromioclavicular dislocations[J].Am J Sports Med,1995,23(3):324-331.
[15]Natera L,Sarasquete Reiriz J,Abat F.Anatomic reconstruction of chronic coracoclavicular ligament tears:arthroscopic-assisted approach with nonrigid mechanical fixation and graft augmentation[J].Arthrosc Tech,2014,3(5):e583-e588.
[16]Lyons FA,Rockwood CA Jr.Migration of pins used in operations on the shoulder[J].J Bone Joint Surg Am,1990,72(8):1262-1267.
[17]Ammon JT,Voor MJ,Tillett ED.A biomechanical comparison of Bosworth and poly-L lactic acid bioabsorbable screws for treatment of acromioclavicular separations[J].Arthroscopy,2005,21(12):1443-1446.
[18]Beitzel K,Cote MP,Apostolakos J,et al.Current concepts in the treatment of acromioclavicular joint dislocations[J].Arthroscopy,2013,29(2):387-397.
[19]Darabos N,Vlahovic I,Gusic N,et al.Is AC TightRope fixation better than Bosworth screw fixation for minimally invasive operative treatment of RockwoodⅢAC joint injury?[J].2015,46(Suppl 6):S113-S118.
[20]Mcconnell AJ,Yoo DJ,Zdero R,et al.Methods of operative fixation of the acromio-clavicular joint:a biomechanical comparison[J].J Orthop Trauma,2007,21(4):248-253.
[21]Tiefenboeck TM,Popp D,Boesmueller S,et al.Acromioclavicular joint dislocation treated with Bosworth screw and additional K-wiring:results after 7.8 years-still an adequate procedure?[J].BMC Musculoskelet Disord,2017,18(1):339.
[22]Gstettner C,Tauber M,Hitzl W,et al.Rockwood typeⅢacromioclavicular dislocation:surgical versus conservative treatment[J].J Shoulder Elbow Surg,2008,17(2):220-225.
[23]Kienast B,Thietje R,Queitsch C,et al.Mid-term results after operative treatment of rockwood gradeⅢ-Ⅴacromioclavicular joint dislocations with an AC-hook-plate[J].Eur J Med Res,2011,16(2):52-56.
[24]Jerosch J,Filler T,Peuker E,et al.Which stabilization technique corrects anatomy best in patients with AC-separation?An experimental study[J].Knee Surg Sports Traumatol Arthrosc,1999,7(6):365-372.
[25]Wellmann M,Zantop T,Weimann A,et al.Biomechanical evaluation of minimally invasive repairs for complete acromioclavicular joint dislocation[J].Am J Sports Med,2007,35(6):955-961.
[26]Patzer T,Clauss C,Kühne CA,et al.Arthroscopically assisted reduction of acute acromioclavicular joint separations:comparison of clinical and radiological results of single versus double TightRopeTMtechnique[J].Unfallchirurg,2013,116(5):442-450.
[27]Walz L,Salzmann GM,Fabbro T,et al.The anatomic reconstruction of acromioclavicular joint dislocations using 2TightRope devices:a biomechanical study[J].Am J Sports Med,2008,36(12):2398-2406.
[28]Hann C,Kraus N,Minkus M,et al.Combined arthroscopically assisted coraco-and acromioclavicular stabilization of acute high-grade acromioclavicular joint separations[J].Knee Surg Sports Traumatol Arthrosc,2018,26(1):212-220.
[29]Horst K,Garving C,Thometzki T,et al.Comparative study on the treatment of Rockwood typeⅢacute acromioclavicular dislocation:clinical results from the TightRope○R technique vs.K-wire fixation[J].Orthop Traumatol Surg Res,2017,103(2):171-176.
[30]Choi NH,Lim SM,Lee SY,et al.Loss of reduction and complications of coracoclavicular ligament reconstruction with autogenous tendon graft in acute acromioclavicular dislocations[J].J Shoulder Elbow Surg,2017,26(4):692-698.
[31]Lee SJ,Nicholas SJ,Akizuki KH,et al.Reconstruction of the coracoclavicular ligaments with tendon grafts:a comparative biomechanical study[J].Am J Sports Med,2003,31(5):648-655.
[32]Tauber M,Gordon K,Koller H,et al.Semitendinosus tendon graft versus a modified Weaver-Dunn procedure for acromioclavicular joint reconstruction in chronic cases:a prospective comparative study[J].Am J Sports Med,2009,37(1):181-190.
[33]Ye G,Peng CA,Sun HB,et al.Treatment of Rockwood typeⅢacromioclavicular joint dislocation using autogenous semitendinosus tendon graft and endobutton technique[J].Ther Clin Risk Manag,2016,12:47-51.
[34]Beitzel K,Sablan N,Chowaniec DM,et al.Sequential resection of the distal clavicle and its effects on horizontal acromioclavicular joint translation[J].Am J Sports Med,2012,40(3):681-685.
[35]Naziri Q,Williams N,Hayes W,et al.Acromioclavicular joint reconstruction using a tendon graft:a biomechanical study comparing a novel“sutured throughout”tendon graft to a standard tendon graft[J].SICOT J,2016,2:17.
[36]Shin SJ,Campbell S,Scott J,et al.Simultaneous anatomic reconstruction of the acromioclavicular and coracoclavicular ligaments using a single tendon graft[J].Knee Surg Sports Traumatol Arthrosc,2014,22(9):2216-2222.
[37]Garofalo R,Ceccarelli E,Castagna A,et al.Open capsular and ligament reconstruction with semitendinosus hamstring autograft successfully controls superior and posterior translation for typeⅤacromioclavicular joint dislocation[J].Knee Surg Sports Traumatol Arthrosc,2017,25(7):1989-1994.
[38]Weaver JK,Dunn HK.Treatment of acromioclavicular injuries,especially complete acromioclavicular separation[J].J Bone Joint Surg Am,1972,54(6):1187-1194.
[39]Motamedi AR,Blevins FT,Willis MC,et al.Biomechanics of the coracoclavicular ligament complex and augmentations used in its repair and reconstruction[J].Am J Sports Med,2000,28(3):380-384.
[40]Hegazy G,Safwat H,Seddik M,et al.Modified weaver-dunn procedure versus the use of semitendinosus autogenous tendon graft for acromioclavicular joint reconstruction[J].Open Orthop J,2016,10:166-178.
[41]Larsen E,Bjerg-Nielsen A,Christensen P.Conservative or surgical treatment of acromioclavicular dislocation:a prospective,controlled,randomized study[J].J Bone Joint Surg Am,1986,68(4):552-555.
[42]Snyder SJ,Banas MP,Karzel RP.The arthroscopic Mumford procedure:an analysis of results[J].Arthroscopy,1995,11(2):157-164.
[43]Branch TP,Burdette HL,Shahriari AS,et al.The role of the acromioclavicular ligaments and the effect of distal clavicle resection[J].Am J Sports Med,1996,24(3):293-297.
[44]Li X,Ma R,Bedi A,et al.Management of acromioclavicular joint injuries[J].J Bone Joint Surg Am,2014,96(1):73-84.
[45]Arirachakaran A,Boonard M,Piyapittayanun P,et al.Post-operative outcomes and complications of suspensory loop fixation device versus hook plate in acute unstable acromioclavicular joint dislocation:a systematic review and meta-analysis[J].J Orthop Traumatol,2017,18(4):293-304.
[2]Zhu NF,Rui BY,Zhang YL,et al.Anatomic study of coracoclavicular ligaments for reconstruction of acromioclavicular joint dislocations[J].J Orthop Sci,2016,21(6):749-752.
[3]Gorbaty JD,Hsu JE,Gee AO.Classifications in brief:Rockwood classification of acromioclavicular joint separations[J].Clin Orthop Relat Res,2017,475(1):283-287.
[4]Maier D,Jaeger M,Reising K,et al.Injury patterns of the acromioclavicular ligament complex in acute acromioclavicular joint dislocations:a cross-sectional,fundamental study[J].BMC Musculoskelet Disord,2016,17(1):385.
[5]Pauly S,Kraus N,Greiner S,et al.Prevalence and pattern of glenohumeral injuries among acute high-grade acromioclavicular joint instabilities[J].J Shoulder Elbow Surg,2013,22(6):760-766.
[6]Murena L,Canton G,Vulcano E,et al.Scapular dyskinesis and SICK scapula syndrome following surgical treatment of typeⅢacute acromioclavicular dislocations[J].Knee Surg Sports Traumatol Arthrosc,2013,21(5):1146-1150.
[7]Longo UG,Ciuffreda M,Rizzello GA,et al.Surgical versus conservative management of typeⅢacromioclavicular dislocation:a systematic review[J].Br Med Bull,2017,122(1):31-49.
[8]Beitzel K,Mazzocca AD,Bak K,et al.ISAKOS upper extremity committee consensus statement on the need for diversification of the Rockwood classification for acromioclavicular joint injuries[J].Arthroscopy,2014,30(2):271-278.
[9]Carbone S,Postacchini R,Gumina S.Scapular dyskinesis and SICK syndrome in patients with a chronic typeⅢacromioclavicular dislocation.Results of rehabilitation[J].Knee Surg Sports Traumatol Arthrosc,2015,23(5):1473-1480.
[10]Jensen G,Katthagen JC,Alvarado LE,et al.Has the arthroscopically assisted reduction of acute AC joint separations with the double tight-rope technique advantages over the clavicular hook plate fixation?[J].Knee Surg Sports Traumatol Arthrosc,2014,22(2):422-430.
[11]Debski RE,Parsons IM 4th,Woo SL,et al.Effect of capsular injury on acromioclavicular joint mechanics[J].J Bone Joint Surg Am,2001,83A(9):1344-1351.
[12]Wellmann M,da Silva G,Lichtenberg S,et al.Instability pattern of acromioclavicular joint dislocations type RockwoodⅢ:relevance of horizontal instability[J].Orthopade,2013,42(4):271-277.
[13]Scheibel M,Dr9schel S,Gerhardt C,et al.Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations[J].Am J Sports Med,2011,39(7):1507-1516.
[14]Weinstein DM,Mccann PD,Mcilveen SJ,et al.Surgical treatment of complete acromioclavicular dislocations[J].Am J Sports Med,1995,23(3):324-331.
[15]Natera L,Sarasquete Reiriz J,Abat F.Anatomic reconstruction of chronic coracoclavicular ligament tears:arthroscopic-assisted approach with nonrigid mechanical fixation and graft augmentation[J].Arthrosc Tech,2014,3(5):e583-e588.
[16]Lyons FA,Rockwood CA Jr.Migration of pins used in operations on the shoulder[J].J Bone Joint Surg Am,1990,72(8):1262-1267.
[17]Ammon JT,Voor MJ,Tillett ED.A biomechanical comparison of Bosworth and poly-L lactic acid bioabsorbable screws for treatment of acromioclavicular separations[J].Arthroscopy,2005,21(12):1443-1446.
[18]Beitzel K,Cote MP,Apostolakos J,et al.Current concepts in the treatment of acromioclavicular joint dislocations[J].Arthroscopy,2013,29(2):387-397.
[19]Darabos N,Vlahovic I,Gusic N,et al.Is AC TightRope fixation better than Bosworth screw fixation for minimally invasive operative treatment of RockwoodⅢAC joint injury?[J].2015,46(Suppl 6):S113-S118.
[20]Mcconnell AJ,Yoo DJ,Zdero R,et al.Methods of operative fixation of the acromio-clavicular joint:a biomechanical comparison[J].J Orthop Trauma,2007,21(4):248-253.
[21]Tiefenboeck TM,Popp D,Boesmueller S,et al.Acromioclavicular joint dislocation treated with Bosworth screw and additional K-wiring:results after 7.8 years-still an adequate procedure?[J].BMC Musculoskelet Disord,2017,18(1):339.
[22]Gstettner C,Tauber M,Hitzl W,et al.Rockwood typeⅢacromioclavicular dislocation:surgical versus conservative treatment[J].J Shoulder Elbow Surg,2008,17(2):220-225.
[23]Kienast B,Thietje R,Queitsch C,et al.Mid-term results after operative treatment of rockwood gradeⅢ-Ⅴacromioclavicular joint dislocations with an AC-hook-plate[J].Eur J Med Res,2011,16(2):52-56.
[24]Jerosch J,Filler T,Peuker E,et al.Which stabilization technique corrects anatomy best in patients with AC-separation?An experimental study[J].Knee Surg Sports Traumatol Arthrosc,1999,7(6):365-372.
[25]Wellmann M,Zantop T,Weimann A,et al.Biomechanical evaluation of minimally invasive repairs for complete acromioclavicular joint dislocation[J].Am J Sports Med,2007,35(6):955-961.
[26]Patzer T,Clauss C,Kühne CA,et al.Arthroscopically assisted reduction of acute acromioclavicular joint separations:comparison of clinical and radiological results of single versus double TightRopeTMtechnique[J].Unfallchirurg,2013,116(5):442-450.
[27]Walz L,Salzmann GM,Fabbro T,et al.The anatomic reconstruction of acromioclavicular joint dislocations using 2TightRope devices:a biomechanical study[J].Am J Sports Med,2008,36(12):2398-2406.
[28]Hann C,Kraus N,Minkus M,et al.Combined arthroscopically assisted coraco-and acromioclavicular stabilization of acute high-grade acromioclavicular joint separations[J].Knee Surg Sports Traumatol Arthrosc,2018,26(1):212-220.
[29]Horst K,Garving C,Thometzki T,et al.Comparative study on the treatment of Rockwood typeⅢacute acromioclavicular dislocation:clinical results from the TightRope○R technique vs.K-wire fixation[J].Orthop Traumatol Surg Res,2017,103(2):171-176.
[30]Choi NH,Lim SM,Lee SY,et al.Loss of reduction and complications of coracoclavicular ligament reconstruction with autogenous tendon graft in acute acromioclavicular dislocations[J].J Shoulder Elbow Surg,2017,26(4):692-698.
[31]Lee SJ,Nicholas SJ,Akizuki KH,et al.Reconstruction of the coracoclavicular ligaments with tendon grafts:a comparative biomechanical study[J].Am J Sports Med,2003,31(5):648-655.
[32]Tauber M,Gordon K,Koller H,et al.Semitendinosus tendon graft versus a modified Weaver-Dunn procedure for acromioclavicular joint reconstruction in chronic cases:a prospective comparative study[J].Am J Sports Med,2009,37(1):181-190.
[33]Ye G,Peng CA,Sun HB,et al.Treatment of Rockwood typeⅢacromioclavicular joint dislocation using autogenous semitendinosus tendon graft and endobutton technique[J].Ther Clin Risk Manag,2016,12:47-51.
[34]Beitzel K,Sablan N,Chowaniec DM,et al.Sequential resection of the distal clavicle and its effects on horizontal acromioclavicular joint translation[J].Am J Sports Med,2012,40(3):681-685.
[35]Naziri Q,Williams N,Hayes W,et al.Acromioclavicular joint reconstruction using a tendon graft:a biomechanical study comparing a novel“sutured throughout”tendon graft to a standard tendon graft[J].SICOT J,2016,2:17.
[36]Shin SJ,Campbell S,Scott J,et al.Simultaneous anatomic reconstruction of the acromioclavicular and coracoclavicular ligaments using a single tendon graft[J].Knee Surg Sports Traumatol Arthrosc,2014,22(9):2216-2222.
[37]Garofalo R,Ceccarelli E,Castagna A,et al.Open capsular and ligament reconstruction with semitendinosus hamstring autograft successfully controls superior and posterior translation for typeⅤacromioclavicular joint dislocation[J].Knee Surg Sports Traumatol Arthrosc,2017,25(7):1989-1994.
[38]Weaver JK,Dunn HK.Treatment of acromioclavicular injuries,especially complete acromioclavicular separation[J].J Bone Joint Surg Am,1972,54(6):1187-1194.
[39]Motamedi AR,Blevins FT,Willis MC,et al.Biomechanics of the coracoclavicular ligament complex and augmentations used in its repair and reconstruction[J].Am J Sports Med,2000,28(3):380-384.
[40]Hegazy G,Safwat H,Seddik M,et al.Modified weaver-dunn procedure versus the use of semitendinosus autogenous tendon graft for acromioclavicular joint reconstruction[J].Open Orthop J,2016,10:166-178.
[41]Larsen E,Bjerg-Nielsen A,Christensen P.Conservative or surgical treatment of acromioclavicular dislocation:a prospective,controlled,randomized study[J].J Bone Joint Surg Am,1986,68(4):552-555.
[42]Snyder SJ,Banas MP,Karzel RP.The arthroscopic Mumford procedure:an analysis of results[J].Arthroscopy,1995,11(2):157-164.
[43]Branch TP,Burdette HL,Shahriari AS,et al.The role of the acromioclavicular ligaments and the effect of distal clavicle resection[J].Am J Sports Med,1996,24(3):293-297.
[44]Li X,Ma R,Bedi A,et al.Management of acromioclavicular joint injuries[J].J Bone Joint Surg Am,2014,96(1):73-84.
[45]Arirachakaran A,Boonard M,Piyapittayanun P,et al.Post-operative outcomes and complications of suspensory loop fixation device versus hook plate in acute unstable acromioclavicular joint dislocation:a systematic review and meta-analysis[J].J Orthop Traumatol,2017,18(4):293-304.