1、.1 郭维.2.3.4.5.6.7.8Tossy JD, Mead NC, Sigmond HM. Acromioclavicular separations: useful and practical classification for treatment. Clin Orthop Relat Res 1963;28:1119.9RockwoodCAJr.Injuriestotheacromioclavicularjoint.In:In:RockwoodCAJr,GreenDP.Fracturesinadults,vol1,2nded.Philadelphia:JBLippincott;1
2、984.p860-910.10RockwoodCAJr.Injuriestotheacromioclavicularjoint.In:In:RockwoodCAJr,GreenDP.Fracturesinadults,vol1,2nded.Philadelphia:JBLippincott;1984.p860-910.11RockwoodCAJr.Injuries to the acromioclavicular joint.In:In:Rockwood CA Jr,Green DP.Fractures in adults,vol1,2nded.Philadelphia:JBLippincot
3、t;1984.p860-910PaulyS,GerhardtC,HaasNP,ScheibelM.Prevalenceofconcomitant intraarticular lesions in patients treated operatively for high-grade acromioclavicular joint separations. Knee Surg Sports Traumatol Arthrosc.2009May;17(5):513-7.Epub2008Nov20.12Xinning Li；Richard Ma.Management of acromioclavi
4、cular joint injuriesThe Journal of Bone and Joint Surgery. American Volume. 2014, 96/A(1)RockwoodCAJr.Injuries to the acromioclavicular joint.In:In:Rockwood CA Jr,Green DP.Fractures in adults,vol1,2nded.Philadelphia:JBLippincott;1984.p860-910.13分型肩锁韧带喙锁韧带三角肌筋膜喙锁关节间隙*肩锁关节影像学表现I型型扭伤未损伤未损伤正常正常II型型断裂扭伤未
5、损伤25%25%增宽III型型断裂断裂断裂25%至100%至100%增宽IV型型断裂断裂断裂增加锁骨向后移位V型型断裂断裂断裂100%至300%至300%N/AVI型型断裂断裂断裂减少锁骨向下移位至喙突下方*通过影像学检查测量喙突上方和锁骨下方之间的距离通过影像学检查测量喙突上方和锁骨下方之间的距离N/A 未提供资料和信息未提供资料和信息Xinning Li；Richard Ma.Management of acromioclavicular joint injuriesThe Journal of Bone and Joint Surgery. American Volume. 2014,
6、96/A(1).14Xinning Li；Richard Ma.Management of acromioclavicular joint injuriesThe Journal of Bone and Joint Surgery. American Volume. 2014, 96/A(1).15Zanca P. Shoulder pain: involvement of the acromioclavicularjoint . (Analysis of 1,000cases). Am J Roentgenol Radium Ther NuclMed.1971Jul;112(3):493-5
7、06.13.16应力 X 线片检查可以鉴别 II 型损伤和 III 型损伤A图为不提重物的表现B图为提重物的表现.17.18.19交胸内收位X线交胸内收位：用于评估肩锁关节稳定。.20直接暴力导致的 III 型肩锁关节损伤 MRI 影像。斜行矢状位 MRI（A）显示喙锁韧带断裂（箭头处），冠状位的 MRI（B）同时证实喙锁韧带断裂.21.22.23.24.25？.26图片来源：Beim GM. Acromioclavicular joint injuries. J Athl Train. 2000:353:261-7).27图片来源：Beim GM. Acromioclavicular joi
8、nt injuries. J Athl Train. 2000:353:261-7).28图片来源：Beim GM. Acromioclavicular joint injuries. J Athl Train. 2000:353:261-7).29 肩锁关节损伤的诊断与分型并不简单，尤其困难的是选择正确的患者实施手术。 ISAKOS建议把Rockwood III型损伤进一步分 为IIIA（稳定）型与IIIB(不稳定)型 肩锁关节脱位引起的韧带损伤需要引起重视，特别是Rockwood分型III型及以上的患者。 目前手术时机与手术方式的选择依然有争议。 由于证据水平的不足，及随访病例数较少，对于
9、手术是否“失败”的评价标准需要重新定义。.30.31.32锁骨骑跨于肩峰之上，这就表明不稳定的肩锁关节及喙锁韧带。.33Ceccarelli等 通过对以往600 多篇关于肩锁关节 型损伤的随机对照试验的文献调研, 发现手术治疗的疗效在统计学上并不比保守治疗占优势；III度损伤通常采用保守，由于对III型肩锁关节损伤没有明确的共识，其治疗方案选择只有基于具体患者具体分析；对于IIIB型手术治疗应更积极。Ceccarelli E, Alviti RF, Garofalo R, etal.Treatment of acute grade acromioclavicular dislocation:a
10、 lack of evidence J .JOrthopaed Traumatol, 2008, 9:105 -108.III型损伤.34.35.36压疮创伤性关节炎神经血管损伤肩关节僵硬锁骨远端骨溶解但是目前尚未有证据证实这些方法能减少关节半脱位Fraser-Moodie JA, Shortt NL, Robinson CM.Injuries to the acromioclavicular joint aspects of current management J .JBoneJointSurgBr,2008, 90:697 -707.37（1）解剖复位肩锁关节（2）修复/重建喙锁韧带；（
11、3）在术后早期，对修复重建的喙锁韧带以及坚强固定的肩锁关节进行支持和保护；（4）修复三角肌及斜方肌筋膜；（5）对出现关节炎表现的患者进行锁骨远端切除手术。手术要求：手术要求：Xinning Li；Richard Ma.Management of acromioclavicular joint injuriesThe Journal of Bone and Joint Surgery. American Volume. 2014, 96/A(1).38.39.40.41-Dunn.42改良的Weaver-Dunn技术.43.44克氏针张力带固定.45克氏针内固定和喙锁韧带缝合术（Phemiste
12、r法）.46.47.48 病人取仰卧位，身体上部略有抬高。 用一可透X线的垫子置于患侧肩下，使术野抬高约30，患者头部转向对侧。.49锁骨远端锁骨远端喙锁韧带喙锁韧带.50.51.52.53.54锁骨远端截骨+克氏针固定.55肌肉动力转位术：Dewar法.56Struhl S. Double Endobutton technique for repair of complete acromioclavicular joint dislocationsJ. Techniques in Shoulder& Elbow Surgery 2007 8 (4): 175-179. 悬吊袢钢板韧带重建术.
13、57Struhl S. Double Endobutton technique for repair of complete acromio- clavicular joint dislocationsJ. Techniques inShoulder& Elbow Surgery 2007 8 (4): 175-179. 术前术后.58三Li Q, Hsueh PL, Chen YF.Coracoclavicular ligament reconstruction: a systematic review and a biomechanical study of a triple endobu
14、tton technique.Medicine (Baltimore). 2014 Dec;93(28):e193. .59三Li Q, Hsueh PL, Chen YF.Coracoclavicular ligament reconstruction: a systematic review and a biomechanical study of a triple endobutton technique.Medicine (Baltimore). 2014 Dec;93(28):e193. .601 2 带线铆钉结合克氏针法3 锁骨钩板联合带线锚钉技术4 联合腱外侧半肌腱反转移位重建喙锁韧带5 肩锁钩钢板联合带线锚钉重建喙锁韧带6 锁骨钩钢板联合喙锁韧带重建等其他方法.61.62后面内容直接删除就行资料可以编辑修改使用资料可以编辑修改使用资料仅供参考，实际情况实际分析.63The user can demonstrate on a projector or computer, or print the presentation and make it into a film to be used in a wider field
