Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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The Necessity of Coracoclavicular Ligament Repair in Open Reduction for the Acromioclavicular Joint Dislocations

견봉 쇄골 관절 탈구의 관혈적 정복술시 오구 쇄골 인대 봉합의 필요성

  • Kim, Eu-Gene (Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Shin, Hun-Kyu (Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Jeong, Haw-Jae (Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Choi, Jae-Yeol (Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Park, Se-Jin (Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Choi, Kyu-Bo (Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Lim, Jong-Jun (Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 김유진 (성균관대학교 의과대학 강북삼성병원 정형외과) ;
  • 신헌규 (성균관대학교 의과대학 강북삼성병원 정형외과) ;
  • 정화재 (성균관대학교 의과대학 강북삼성병원 정형외과) ;
  • 최재열 (성균관대학교 의과대학 강북삼성병원 정형외과) ;
  • 박세진 (성균관대학교 의과대학 강북삼성병원 정형외과) ;
  • 최규보 (성균관대학교 의과대학 강북삼성병원 정형외과) ;
  • 임종준 (성균관대학교 의과대학 강북삼성병원 정형외과)
  • Received : 2010.07.30
  • Accepted : 2010.11.05
  • Published : 2010.12.15
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Abstract

Purpose: We evaluated clinical and radiological results for open reduction and internal fixation of acromioclavicular dislocation without coracoclavicular ligament repair after removal of implants. Materials and methods: Clinical and radiological results were obtained for 53 patients who underwent open reduction and internal fixation of an acromioclavicular joint dislocation between 1998 and 2007. A total of 21 patients were treated with a modified-Phemister method and 32 patients were treated with a Hook plate method. All subjects were surveyed after removal of their implants. The Constant scoring system was administered postoperatively to evaluate clinical results. Radiologic outcomes were evaluated by both coracoclavicular intervals on plain films. Results: Constant scores were $87.59{\pm}7.8$ in the Phemister group and $89.35{\pm}5.3$ in the Hook plate group. For both groups, the mean coracoclavicular interval at preoperative radiography was 15.9 mm at the injured site and 8.0 mm at the opposite site. After metal removal, the mean difference between coracoclavicular distances between normal and injured sites were 1.0 mm for the Hook plate group and 1.2 mm for the modified Phemister method group (p>0.05). Conclusion: Open reduction and internal fixation of an acromioclavicular joint without coracoclavicular ligament repair shows good long-term clinical and radiological results.

목적: 오구 쇄골 인대를 봉합하지 않고 견봉 쇄골 관절의 관혈적 정복만 시행한 환자군에서의 임상적, 방사선학적 추시 결과를 확인하고자 하였다. 대상 및 방법: 1998년부터 2007년까지 변형 Phemister 술식과 갈고리 금속판 (AO hook 금속판, Wolter 금속판)을 사용하여 견봉 쇄골 관절 탈구로 수술 받은 환자 중 삽입물 제거한 53예를 대상으로 하였다. 변형 Phemister 술식을 사용한 군이 21명, 갈고리 금속판을 사용한 군이 32명 이였다. 임상적 평가는 Constant score를 이용하였으며, 양측 쇄골과 오구돌기 사이의 수직 거리를 비교하여 방사선적 평가를 하였다. 결과: Constant score는 변형 Phemister 술식을 사용한 군에서는 $87.59{\pm}7.8$, 갈고리 금속판을 사용한 군에서는 $89.35{\pm}5.3$로 통계학적 차이는 없었다. 두 군에서 수술 전 손상 부위의 쇄골 오구돌기의 평균 거리는 15.9 mm이였으며, 건측 견관절은 평균 8.0 mm이였다. 갈고리 금속판 환자군에서 건측과 비교하여 평균 1.0 mm, 변형 Phemister 환자군에서는 평균 1.2 mm의 수직 전위가 관찰되었으며 통계학적 차이는 없었다. 결론: 오구쇄골 인대를 복원 하지 않은 견봉 쇄골 관절 탈구의 관혈적 정복술 및 내고정술은 양호한 임상적, 방사선학적 결과를 보였다.

Keywords

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