肩锁关节脱位治疗面临的挑战：目前观念。
Journal of the American Academy of Orthopaedic Surgeons
1. 肩锁关节的解剖
由锁骨远端与肩峰构成的关节，由关节囊、肩锁韧带、喙锁韧带等结构固定，维持关节的稳定性。此关节为微动关节。
2.肩锁关节脱位
肩关节常见损伤，即肩峰与锁骨远端分离移位。临床表现为肩部疼痛、肿胀、关节活动受限。
3.肩锁关节脱位的Rockwood分型（主流）
基于正位X线的分型，分为6型，表格如下。AC肩锁韧带，CC喙锁韧带。
4. 基于Rockwood分型的肩锁关节治疗
I型、II型可保守治疗。患肢悬吊固定2-4周。
III型可保守治疗或手术治疗。目前认为手术治疗效果优于保守治疗。
IV-V型首选手术治疗（勾钢板、关节镜下Endobutton袢钢板、韧带重建）
VI型极为少见，一旦发生需行手术治疗。
勾钢板治疗肩锁关节脱位
Endobutton袢钢板治疗肩锁关节脱位
极为少见的VI型肩锁关节脱位
4.锁骨远端切除对于肩锁关节慢性疼痛效果良好（1cm锁骨远端切除或0.5cm肩峰+0.5cm锁骨远端，目前通常在关节镜下施行）。
关节镜下锁骨远端切除治疗肩锁关节疼痛
参考文献
[1] A. Arismendi, H. Gallego, D. Galeano, C. Hurtado, A.M. Herrera, Subacute Acromioclavicular Dislocation after Basal Coracoid Process Fracture: Indirect Reduction without Open Reduction and Internal Fixation: A Case Report, JBJS Case Connect. 10 (2020) 19–23. https://doi.org/10.2106/JBJS.CC.19.00637.
[2] J.P. Yoon, B.J. Lee, S.J. Nam, S.W. Chung, W.J. Jeong, W.K. Min, J.H. Oh, Comparison of results between hook plate fixation and ligament reconstruction for acute unstable acromioclavicular joint dislocation, CiOS Clin. Orthop. Surg. 7 (2015) 97–103. https://doi.org/10.4055/cios.2015.7.1.97.
[3] Y. Liu, X. Zhang, Y. Yu, W. Ding, Y. Gao, Y. Wang, R. Yang, V. Dhawan, Suture augmentation of acromioclavicular and coracoclavicular ligament reconstruction for acute acromioclavicular dislocation, Medicine (Baltimore). 100 (2021) e27007. https://doi.org/10.1097/MD.0000000000027007.
[4] T. Schöbel, J. Theopold, J.P. Fischer, S. Löffler, S. Schleifenbaum, P. Hepp, Anatomical versus non-anatomical configuration of double coraco-clavicular tunnel technique in acromioclavicular joint reconstruction, Arch. Orthop. Trauma Surg. (2021). https://doi.org/10.1007/s00402-021-03894-0.
[5] J.O. Ranne, S.O. Salonen, J.T. Lehtinen, Arthroscopy-Assisted Reconstruction of the Coracoclavicular and Acromioclavicular Ligaments Using a Tendon Graft and Knot-Hiding Clavicular Implants in Chronic Acromioclavicular Separations, Arthrosc. Tech. 10 (2021) e855–e859. https://doi.org/10.1016/j.eats.2020.10.077.
[6] J.Y. Kim, S. Bryant, B. Gardner, H.Y. Park, W. Tse, M. Chakrabarti, P. McGahan, J.L. Chen, Distal Clavicle Excision for Acromioclavicular Joint Osteoarthritis Using a Fluoroscopic Kirschner Wire Guide, Arthrosc. Tech. 10 (2021) e359–e365. https://doi.org/10.1016/j.eats.2020.10.010.
[7] H.M. Chang, C.K. Hong, W.R. Su, T.H. Wang, C.W. Chang, T.W. Tai, Comparison of clavicular hook plate with and without coracoclavicular suture fixation for acute acromioclavicular joint dislocation, Acta Orthop. Traumatol. Turc. 53 (2019) 408–413. https://doi.org/10.1016/j.aott.2019.08.002.
[8] J.B. Cook, K.P. Krul, Challenges in treating acromioclavicular separations: Current concepts, J. Am. Acad. Orthop. Surg. 26 (2018) 669–677. https://doi.org/10.5435/JAAOS-D-16-00776.
美句欣赏：做一朵向日葵，面朝太阳，心纳阳光。
欢迎批评指正。
联系客服
