骨科英文书籍精读（65）｜胸锁关节脱位

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STERNOCLAVICULAR DISLOCATIONS

Mechanism of injury

This uncommon injury is usually caused by lateral compression of the shoulders; for example, when someone is pinned to the ground following a road accident or an underground rock-fall. Rarely, it fol-lows a direct blow to the front of the joint. Anterior dislocation is much more common than posterior. The joint can be sprained, subluxed or dislocated.

Clinical features

Anterior dislocation is easily diagnosed; the dislocated medial end of the clavicle forms a prominent bump over the sternoclavicular joint. The condition is painful but there are usually no cardiothoracic com-plications.

Posterior dislocation, though rare, is much more serious. Discomfort is marked; there may be pressure on the trachea or large vessels, causing venous congestion of the neck and arm and circulation to the arm may be decreased.

X-Ray

Because of overlapping shadows, plain x-rays are difficult to interpret. Special oblique views are helpful and CT is the ideal method.

Treatment

Sprains and subluxations do not require specific treatment.

Anterior dislocation can usually be reduced by exerting pressure over the clavicle and pulling on the arm with the shoulder abducted. However, the joint usually redislocates. Not that this matters much; full function will be regained, though this may take several months.

Internal fixation is unnecessary and very dangerous (because of the large vessels behind the sternum).

Posterior dislocation should be reduced as soon as possible. This can usually be done closed (if necessary under general anaesthesia) by lying the patient supine with a sandbag between the scapulae and then pulling on the arm with the shoulder abducted and extended. The joint reduces with a snap and stays reduced. If this manoeuvre fails, the medial end of the clavicle is grasped with bone forceps and pulled forwards. If this too, fails (a very rare occurrence) open reduction is justified, but great care must be taken not to damage the mediastinal structures. After reduction, the shoulders are braced back with a figure-of-eight bandage, which is worn for 3 weeks.

---from 《Apley’s System of Orthopaedics and Fractures》P739

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重点词汇整理：

trachea  /ˈtreɪkiə/n. [脊椎][解剖] 气管；[植] 导管

oblique /əˈbliːk/n. 倾斜物adj. 斜的；不光明正大的vi. 倾斜

exert /ɪɡˈzɜːrt/vt. 运用，发挥；施以影响

sternum /ˈstɜːrnəm/n. [解剖] 胸骨

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百度翻译：

胸锁关节脱位

损伤机制

这种罕见的伤害通常是由肩部的侧向压缩引起的；例如，当有人在道路事故或地下岩石坠落后被压在地上。很少，它会直接打击关节前部。前脱位比后脱位更常见。关节可能扭伤、半脱位或脱臼。

临床特征

前脱位很容易诊断；脱臼的锁骨内侧端在胸锁关节上形成一个突出的肿块。这种情况很痛苦，但通常没有心胸复合物。

后脱位虽然少见，但严重得多。明显不适；气管或大血管可能受压，导致颈部和手臂静脉充血，手臂循环可能会减少。

X射线

由于阴影重叠，普通的x射线很难解释。特殊的斜视是有帮助的，CT是理想的检查方法。

治疗

扭伤和半脱位不需要特殊治疗。

前脱位通常可以通过对锁骨施加压力并在肩部外展的情况下拉动手臂来减轻。然而，关节通常会重新定位。这并不重要；虽然可能需要几个月的时间，但全部功能将恢复。

内固定是不必要的，而且非常危险（因为胸骨后面有大血管）。

后脱位应尽快复位。这通常可以关闭（如有必要，在全身麻醉下），将患者平躺在肩胛骨之间的沙袋中，然后在肩膀外展和伸展的情况下拉动手臂。关节突然减少并保持减少。如果这个动作失败，锁骨的内侧端用骨钳抓住并向前拉。如果这也是失败的（很少发生）切开复位是合理的，但必须非常小心不要损坏纵隔结构。复位后，用8字形绷带将肩膀向后支撑，绷带要戴3周。

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