摘要
目的探讨改良肩锁关节X线轴位投射照相技术的临床应用价值以及对应的解剖基础。方法选取2014年6月1日至2016年3月1日在该院骨科病房治疗的30例有明确外伤史,受伤后2周内行手术治疗的肩锁关节脱位的患者。根据X线拍照技术的不同分成常规组和轴位组,每组各15例。常规组患者拍肩部前后位X线片和肩部应力负重位X线片,轴位组在此基础上,加拍肩锁关节X线轴位片。比较两组患者肩锁关节脱位的类型及严重程度,记录患者锁骨远端向后移位和三角肌、关节囊、斜方肌、肩锁韧带的损伤情况。结果常规组与轴位组相比,肩锁关节脱位的类型及严重程度差异无统计学意义(P>0.05)。两组患者三角肌、关节囊、斜方肌、肩锁韧带损伤诊断准确率的差异无统计学意义(P>0.05)。常规组患者锁骨远端向后移位诊断准确率明显低于轴位组,差异有统计学意义(P<0.05)。结论采用改良肩锁关节X线轴位投照技术,可以观察到锁骨远端向后移位情况,提高锁骨远端向后移位诊断的准确率,可在临床推广使用。
Objective To explore the clinical value of modified acromioclavicular joint X-ray axial projection technique and the corresponding anatomical basis.Methods A total of 30 patients with clear trauma history were selected from June 1,2014 to March 1,2016 in our hospital orthopedic ward.And patients who had undergone acromioclavicular joint dislocation within two weeks after injury.According to the different X-ray photography technology,patients were divided into two conventional group and axial group,15 cases in each group.The conventional group of patients had taken the shoulder X-ray of anteroposterior position and shoulder stress position.And the the shoulder acupuncture joint X-ray was added in axial group.The type and severity of acromioclavicular joint dislocation were compared between the two groups.The distal displacement of the clavicle and the injury of the deltoid,joint capsule,trapezius and acromioclavicular ligament were recorded and analyzed.Results There was no statistical difference in the type and severity of acromioclavicular dislocation compared with the axial group(P>0.05).There was no significant difference in the accuracy of diagnosis of deltoid,joint capsule,trapezius and acromioclavicular ligament injury between the two groups(P>0.05).The diagnostic accuracy of distal retinal detachment in the conventional group was significantly lower than in the axial group(P<0.05).Conclusion The improved acromioclavicular joint X-ray axial projection technique could be used to observe the posterior displacement of the distal clavicle which cannot be observed in the past,so as to improve the accuracy of the diagnosis of the posterior transposition of the distal clavicle.It could be popularized in clinic.
引文
[1]BABHULKAR A,PAWASKAR A.Acromioclavicular joint dislocations[J].Curr Rev Musculoskelet Med,2014,7(1):33-39.
[2]程德良,吴冰,吴天泉,等.双Endobutton带袢钢板治疗RockwoodⅢ型及以上肩锁关节脱位18疗效分析[J].浙江医学,2015,37(5):415-416.
[3]林忠勤,姚剑川,张鸿振,等.TWINFIX TI QUICK-T锚钉联合Endobutton钢板治疗RockwoodⅢ~Ⅴ型肩锁关节脱位[J].中国中医骨伤科杂志,2015,23(10):52-54.
[4]METZLAFF S,ROSSLENBROICH S,FORKEL P H,et al.Surgical treatment of acute acromioclavicular joint dislocations:hook plate versus minimally invasive reconstruction[J].Knee Surg Sports Traumatol Arthrosc,2016,24(6):1972-1978.
[5]吴小宇,欧阳群,李梅.肩关节损伤采用弹性筒子外固定治疗的临床应用[J].当代医学,2015,21(25):35-36.
[6]陈家富,张迪.肩锁关节脱位影像学诊断及治疗现状[J].安徽医学,2016,37(4):492-495.
[7]宫玉锁,蒋国鹏,谢兴文,等.肩锁关节损伤的治疗进展[J].中国中医骨伤科杂志,2016,24(10):79-82.
[8]梁勰敏,李宽俊,杨荣轩.不同吊带对早期偏瘫患者肩关节半脱位的疗效观察[J].医药卫生,2016,1(8):221.
[9]薛培璘,陈云丰.肩锁关节脱位影像学诊断进展[J].国际骨科学杂志,2015,36(5):378-381.
[10]霍忠超,刘晓霞,王雪玲,等.负载肺癌全抗原的自体树突状细胞诱导T细胞反应的体外研究[J].疑难病杂志,2015,14(2):175-178.
[11]BERIS A,LYKISSAS M,KOSTAS-AGNANTIS I,et al.Management of acute acromioclavicular joint dislocation with a double-button fixation system[J].Injury,2013,44(3):288-292.
[12]王智勇,钟秀,张云凤.医学影像学在临床骨科中的应用进展[J].中国卫生产业,2016,13(27):196-198.
