肩锁关节脱位的诊疗现状

Status of acromioclavicular dislocation diagnosis and treatment

肩锁关节脱位(ACD)是一种常见的肩部损伤,由肩关节创伤引起,伤后易造成患者患侧上肢不同程度的疼痛及功能障碍,其诊断主要依靠肩关节X线和肩关节CT等影像学检查。目前临床上广泛采用Rockwood分型系统对ACD进行分类,并依此分类选择合适的治疗方式,其中Ⅰ、Ⅱ型ACD可行保守治疗,Ⅳ~Ⅵ型ACD以手术治疗为主,Ⅲ型ACD的治疗方式争议较大,需根据患者自身特点选择合适的治疗方式。手术治疗ACD的方式主要有关节间固定、喙锁间固定、韧带解剖重建和关节镜技术,其中解剖重建更接近肩锁关节的生理结构,临床满意度较高,关节镜技术的发展使ACD的手术治疗方式朝着微创方向发展。本文从解剖学、损伤机制、诊断、分型、治疗方式的选择及各类手术方式的特点对ACD的诊治作一系统综述,希望为ACD的基础和临床研究提供一些参考。

Acromioclavicular dislocation(ACD)is a common shoulder injury caused by shoulder trauma,which is easy to cause varying degrees of pain and dysfunction in the affected upper limb of the patient.Its diagnosis mainly depends on shoulder X-ray and CT imaging examination.Currently,Rockwood classification system is widely used to classify ACD in clinical practice,and appropriate treatment methods are selected according to this classification.TypeⅠandⅡACD can be treated conservatively,typeⅣ-ⅥACD is mainly treated by surgery.The treatment method of typeⅢACD is controversial,appropriate treatment methods should be selected according to the characteristics of patients.The surgical treatment of ACD mainly involves interarticular fixation,coracoclavicular fixation,anatomical reconstruction and arthroscopic techniques.Among these method,anatomical reconstruction is closer to the physiological structure of acromioclavicular joint,and clinical satisfaction is higher.The development of arthroscopy technology makes the surgical treatment of ACD develop toward minimally invasive direction.This article reviews the diagnosis and treatment of ACD from the perspectives of anatomical injury mechanism diagnosis,classification and treatment and the characteristics of various surgical methods,hoping to provide some reference for basic and clinical research of ACD.