DOI QR코드

DOI QR Code

Open Reduction of Acromioclavicular Joint for the Acromioclavicular Joint Dislocations

견봉 쇄골 관절 탈구에 대한 견봉 쇄골 관절의 관혈적 정복술

  • Song, Hyun-Seok (Department of Orthopedic Surgery, St.Paul's Hospital, The Catholic University of Korea) ;
  • Choi, Nam-Yong (Department of Orthopedic Surgery, St.Paul's Hospital, The Catholic University of Korea) ;
  • Han, Suk-Ku (Department of Orthopedic Surgery, St.Paul's Hospital, The Catholic University of Korea) ;
  • Nah, Ki-Ho (Department of Orthopedic Surgery, St.Paul's Hospital, The Catholic University of Korea) ;
  • Nam, Won-Sik (Department of Orthopedic Surgery, St.Paul's Hospital, The Catholic University of Korea) ;
  • Yang, Hyuk-Jae (Department of Orthopedic Surgery, St.Paul's Hospital, The Catholic University of Korea) ;
  • Park, Sung-Jin (Department of Orthopedic Surgery, St.Paul's Hospital, The Catholic University of Korea)
  • 송현석 (가톨릭대학교 의과대학 성바오로병원 정형외과학교실) ;
  • 최남용 (가톨릭대학교 의과대학 성바오로병원 정형외과학교실) ;
  • 한석구 (가톨릭대학교 의과대학 성바오로병원 정형외과학교실) ;
  • 나기호 (가톨릭대학교 의과대학 성바오로병원 정형외과학교실) ;
  • 남원식 (가톨릭대학교 의과대학 성바오로병원 정형외과학교실) ;
  • 양혁재 (가톨릭대학교 의과대학 성바오로병원 정형외과학교실) ;
  • 박성진 (가톨릭대학교 의과대학 성바오로병원 정형외과학교실)
  • Published : 2006.12.15

Abstract

Purpose: To analyze the result of the accurate open reduction of acromioclavicular (AC) joint and pin fixation, coracoclavicular (CC) screw fixation without CC ligament repair for AC joint injuries. Materials and Methods: Between January 2000 and December 2003, seventeen cases with at least one year follow-up among twenty-one cases underwent operation for AC-CC ligament injuries. A transverse incision approximately 5 cm in length was made over the clavicle, and the AC joint was reduced accurately. Under the image intensifier, a cannulated screw and washer were inserted for the CC ligament. Two Steinman pins were inserted for the AC joint and the AC ligament was repaired with nonabsorbable suture. Gentle passive range of motion was begun postoperative 2 weeks. The pins were removed at $6{\sim}8$ weeks and the screw was removed at $10{\sim}12$ weeks. The results were evaluated by a distance between AC and CC joints on plain films and ASES score at last follow-up. Results: At the last follow-up, there was no limitation of motion and average ASES score was 96($86{\sim}100$ points). There was no failure showing over 5 mm difference of distance compared to opposite side on the plain films. Seven cases had the skin damages and local infection due to pin migration and three cases showed the loosening of CC screw. Conclusion: We could have satisfactory results by accurate reduction of AC joint and simple pins and screw fixation for AC-CC ligament injuries.

Keywords

References

  1. 김영규: 스포츠 활동과 연관된 견봉 쇄골 관절 손상: 견봉 쇄골 관절의 해부학 및 생역학. 대한정형외과스포츠의학회지, 5:4-8, 2006.
  2. 박태수, 김종헌: 견봉 쇄골 관절의 스포츠 손상에 대한 관혈적 대 관절경적 원위 쇄골 절제술. 대한정형외과스포츠의학회지, 5:1-3, 2006.
  3. 유재철, 송백용, 김승연, 임태강, 정주선: 반건양건을 이용한 오구쇄골 인대 재건술후 발생한 원위부 쇄골 터널 확장: 증례 보고. 대한견주관절학회 지, 8:131-134, 2005. https://doi.org/10.5397/CiSE.2005.8.2.131
  4. 전 철 홍, 심 대 무, 김 정 우, 정 을 오, 이 종 명, 이 병 창: 급성 견봉쇄골관절 탈구에서 변형된 Phemister 술식과 C-C sling 술식의 결과 비교. 대한견주관절 학회지, 9:60-67, 2006. https://doi.org/10.5397/CiSE.2006.9.1.060
  5. 최 선 진, 박 한 성, 김 상 효: LIGASTIC 인공인대를 이용한 급성 견봉 쇄골 탈구의 수술적 치료. 대한견주관절학회지, 8:135-140, 2005. https://doi.org/10.5397/CiSE.2005.8.2.135
  6. Bargren JH, Erlanger S and Dick HM: Biomechanics and comparison of two operative methods of treatment of complete acromioclavicular separation. Clin Orthop, 130:267-272, 1978.
  7. Debski RE, Parson IMr, Fenwick J and Vangura A: Ligament mechanics during three degree-of-freedom motion at the ac joint. Ann Biomed Eng, 28:612-618, 2000. https://doi.org/10.1114/1.1304848
  8. Deshmukh AV, Wilson DR, Zilberfarb JL and Perlmutter GS: Stability of acromioclavicular joint reconstruction: Biomechanical testing of various surgical techniques in a cadaveric model. Am J Sports Med, 32:1492-1498, 2004. https://doi.org/10.1177/0363546504263699
  9. Dumonski M, Mazzocca AD, Rios C, Romeo AA and Arciero RA: Evaluation and management of acromioclavicular joint injuries. Am J Orthop, 33:526-532, 2004.
  10. Dumontier C, Sautet A, Man M and Apoil A: Acromioclavicular dislocations: Treatment by coracoacromial ligamentoplasty. J Shoulder Elbow Surg, 4:130-134, 1995. https://doi.org/10.1016/S1058-2746(05)80067-9
  11. Ejeskar A: Coracoclavicular wiring for acromioclavicular joint dislocation: A ten year follow-up study. Acta Orthop Scand, 45:652-661, 1974. https://doi.org/10.3109/17453677408989674
  12. Harris RI, Wallace AL, Harper GD, Goldberg JA, Sonnabend DH and Walsh WR: Structural properties of the intact and the reconstructed coracoclavicular ligament complex. Am J Sports Med, 28:103-108, 2000.
  13. Jones HP, Lemos MJ and Schepsis AA: Salvage of failed acromioclavicular joint reconstruction using autogenous semitendinosus tendon form the knee. Am J Sports Med, 29:234-237, 2001.
  14. Kappakas GS and McMaster JH: Repair of acromioclavicular separation using a dacron prosthesis graft. Clin Orthop, 131:247-251, 1978.
  15. Kennedy JC and Cameron H: Complete dislocation of the acromioclavicular joint. J Bone Joint Surg, 36-B:202-208, 1954.
  16. Kiefer H, Claes L, Burri C and Holzwarth J: The stabilizing effect of various implants on the torn acromioclavicular joint-a biomechanical study. Arch Orthop Trauma Surg, 106:42-46, 1986. https://doi.org/10.1007/BF00435651
  17. Larson E and Hede A: Treatment of acute acromioclavicular dislocation : Three different methods of treatment prospectively studied. Acta Orthop Belg, 53:480-484, 1987.
  18. Lee KW, Debski RE, Chen CH, Woo SL and Fu FH: Functional evaluation of the ligaments at the acromioclavicular joint during anteroposterior and superoinferior translation. Am J Sports Med, 25:858-862, 1997. https://doi.org/10.1177/036354659702500622
  19. Neer CSI: Shoulder reconstruction. Philadelphia, WB Saunders & Co:341-355, 1990.
  20. Neviaser JS: Acromioclavicular dislocation treated by transference of the coracoacromial ligament : A long term follow-up in a series of 112 cases. Clin Orthop, 58:57-68, 1968.
  21. Paavolainen P, Bjorkenheim JM, Paukku P and Slatis P: Surgical treatment of acromioclavicular dislocation : A review of 39 patients. Injury, 14:415-420, 1983. https://doi.org/10.1016/0020-1383(83)90092-X
  22. Phillips A, Smart C and Groom A: Acromioclavicular dislocation. Clin Orthop, 353:10-17, 1998. https://doi.org/10.1097/00003086-199808000-00003
  23. Press J, Zuckerman JD, Gallagher M and Cuomo F: Treatment of grade iii acromioclavicular separations. Operative versus nonoperative management. Bull Hosp Jt Dis, 56:77-83, 1997.
  24. Rockwood CA, Matsen FA, Wirth MA and Lippitt SB: The shoulder. Philadelphia, Pennsylvania, SAUNDERS:532-537, 2004.
  25. Skjeldal S, Lundblad R and Dullerud R: Coracoid process transfer for acromioclavicular dislocation. Acta Orthop Scand, 59:180-182, 1988. https://doi.org/10.1080/17453678809169704
  26. Smith MJ and Stewart MJ: Acute acromioclavicular separation. A 20-year study. Am J Sports Med, 7:62-71, 1979. https://doi.org/10.1177/036354657900700113
  27. Tienen TG, Oyen JF and Eggen PJ: A modified technique of reconstruction for complete acromioclavicular dislocation: A prospective study. Am J Sports Med, 31:655-659, 2003.
  28. Vagas L: Repair of complete acromioclavicular dislocation, utilizing the short head of the biceps. J Bone Joint Surg, 24-A:772-773, 1942.
  29. Weaver JK and Dunn HK: Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg, 54-A:1187-1194, 1972.
  30. Weinstein DM, McCann PD, McIlveen SJ, Flatow EL and Bigliani LU: Surgical treatment of complete acromioclavicular dislocations. Am J Sports Med, 23:324-331, 1995. https://doi.org/10.1177/036354659502300313
  31. Wilson DR, Moses JM, Zilberfarb JL and Hayes WC: Mechanics of coracoacromial ligament transfer augmentation for acromioclavicular joint injuries. J Biomech, 38:615-619, 2005. https://doi.org/10.1016/j.jbiomech.2004.04.015