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中华肩肘外科电子杂志 ›› 2020, Vol. 08 ›› Issue (02) : 101 -106. doi: 10.3877/cma.j.issn.2095-5790.2020.02.002

所属专题: 文献

论著

肩锁关节损伤合并盂肱关节周围组织损伤的调查
严钰皓1, 钟喜红1, 刘选泽1, 肖国庆1,()   
  1. 1. 610051 成都医学院第二附属医院·核工业四一六医院骨科
  • 收稿日期:2019-03-18 出版日期:2020-05-05
  • 通信作者: 肖国庆

Investigation of acromioclavicular joint injury combined with surrounding tissue injury of glenohumeral joint

Yuhao Yan1, Xihong Zhong1, Xuanze Liu1, Guoqing Xiao1,()   

  1. 1. Department of Orthopaedics, The Second Affiliated Hospital of Chengdu Medical College, Chengdu 610051, China
  • Received:2019-03-18 Published:2020-05-05
  • Corresponding author: Guoqing Xiao
  • About author:
    Corresponding author: Xiao Guoqing, Email:
引用本文:

严钰皓, 钟喜红, 刘选泽, 肖国庆. 肩锁关节损伤合并盂肱关节周围组织损伤的调查[J/OL]. 中华肩肘外科电子杂志, 2020, 08(02): 101-106.

Yuhao Yan, Xihong Zhong, Xuanze Liu, Guoqing Xiao. Investigation of acromioclavicular joint injury combined with surrounding tissue injury of glenohumeral joint[J/OL]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2020, 08(02): 101-106.

目的

了解肩锁关节损伤合并盂肱关节周围组织损伤的情况及预后,分析讨论出现各种合并症的原因。

方法

2015年1月至2018年8月收集了共52例肩锁关节损伤患者,分别记录肩锁关节损伤Rockwood分型,受伤机制,术前和术后12个月视觉模拟评分(visual analogue scale,VAS),术后2个月、6个月、12个月Constant评分。

结果

52例患者中,合并损伤占总数32.69%,其中11例患者进行了额外的手术治疗。术前、术后VAS评分比较差异无统计学意义(P>0.05)。盂肱关节合并伤手术治疗的患者,术后12个月随访,Constant评分没有明显好于未额外手术治疗的合并症患者(P>0.05)。

结论

治疗肩锁关节的同时,仔细查验是否存在合并伤,并及时针对合并伤进行手术治疗,对肩关节功能恢复具有重要意义。

Background

Acromioclavicular joint injury is the most common type of shoulder joint injuries. Approximately 9%-12% of patients with scapular injuries are acromioclavicular joints injuries. Every year, it is estimated that 1.8 per 1,000 people will be found acromioclavicular joint injury. Most of the patients are young people or people with some intensity of activity, especially athletes engaged in high-intensity confrontation sports, the proportion has reached 43% -50%. Most acromioclavicular joint injuries are caused by direct impact on the shoulder joint with greater force, such as landing on the shoulder joint while falling or traffic accident. At the time of trauma, the shoulder joint is in the adduction position or, in a few cases, the upper arm passive external rotation. In the process of injury, the elbow joint or hand is kept in a continuous straight position, making the humeral head move upward and impinges on the acromion, which is easy to cause dislocation of the acromioclavicular joint. However, we found from clinical practice and literature reports that, under the direct and indirect injury mechanism, scapular injury is not only the single acromioclavicular joint injury, but also may be associated with the surrounding tissue injury of glenohumeral joint. Especially after arthroscopic treatment of acromioclavicular joint dislocation has been paid more attention to, diagnostic arthroscopy can more clearly and accurately identify the surrounding tissue injuries of glenohumeral joint in addition to acromioclavicular joint injury. The acromioclavicular joint is easy to be damaged when the impact conduction of large force passes through the shoulder joint. However, the remaining impact energy will continue to affect and even destroy the tissue around the acromioclavicular joint, resulting in damage to the surrounding tissue, such as SLAP injury, Bankart injury, rotator cuff injury, etc. Because the injury mechanism of acromioclavicular joint injury is similar to that of combined injury, and the pain of acromioclavicular joint mostly covers the symptoms of combined injury, the symptoms of acromioclavicular joint injury tend to cover the possible complications. As a result, only acromioclavicular joint injury was managed in the treatment. Therefore, when patients have persistent postoperative shoulder pain or the improvement of shoulder joint activity is not obvious, we should be alert to the presence of shoulder joint complications. At present, the diagnostic examination under arthroscopy is sensitive and specific shoulder joint complications, and timely screening and surgical treatment of surrounding tissue injuries of glenohumeral joint is of great significance to the prognosis in this type of patients after surgery.

Objective

To understand the situation and prognosis of acromioclavicular joint injury combined with surrounding tissue injury of glenohumeral joint, and to analyze and discuss the causes of various comorbidities.

Methods

Fifty-two cases of acromioclavicular joint injuries were recorded. Rockwood classification, injury mechanism, VAS score at 12 months before and after operation, and Constant scores at 2, 6, and 12 months after operation were recorded.

Results

In 52 patients, the combined injuries accounted for 32.69%, and 11 patients underwent additional surgical treatment. There was no statistically significant difference in VAS scores before and after surgery (P>0.05) . After 12 months of follow-up, the Constant score of patients with glenohumeral joint combined injury undergoing surgical treatment was not better than that of patients without additional surgical treatment (P>0.05) .

Conclusions

When treating the acromioclavicular joint, it is important to carefully examine whether there is a combined injury. Timely surgical treatment for combined injuries is of great significance to the recovery of shoulder joint function.

表1 肩锁关节脱位类型相关损伤的发生率及治疗方法
表2 三组患者术前、术后12个月VAS评分比较(分)
表3 三组患者术后2个月和12个月Constant评分比较(分)
表4 52例患者损伤原因
表5 52例患者工作类型
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