Clinics in Shoulder and Elbow

대한견·주관절의학회 (Korean Shoulder and Elbow Society)
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견봉쇄골 관절의 급성 탈구에서 원추인대 기능의 강화를 위한 봉합 나사못을 추가한 변형된 Phemister 술식

The Modified Phemister Operation with the Suture Anchor Added for the Augmentation of Conoid Ligament in Acute Acromioclavicular Dislocation

  • 문기혁 (포항성모병원 정형외과) ;
  • 남일현 (포항성모병원 정형외과) ;
  • 이영현 (포항성모병원 정형외과) ;
  • 김기철 (포항성모병원 정형외과) ;
  • 이재훈 (포항성모병원 정형외과) ;
  • 안길영 (포항성모병원 정형외과)
  • Moon, Gi-Hyuk (Department of Orthopedic Surgery, Pohang St. Mary's Hospital) ;
  • Nam, Il-Hyun (Department of Orthopedic Surgery, Pohang St. Mary's Hospital) ;
  • Lee, Yeong-Hyun (Department of Orthopedic Surgery, Pohang St. Mary's Hospital) ;
  • Kim, Ki-Choul (Department of Orthopedic Surgery, Pohang St. Mary's Hospital) ;
  • Lee, Jae-Hoon (Department of Orthopedic Surgery, Pohang St. Mary's Hospital) ;
  • Ahn, Gil-Yeong (Department of Orthopedic Surgery, Pohang St. Mary's Hospital)
  • 투고 : 2010.04.15
  • 심사 : 2010.06.02
  • 발행 : 2010.06.15
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초록

목적: 견봉쇄골 관절의 급성 탈구에서 원추인대 기능의 강화를 위한 봉합 나사못을 추가한 변형된 Phemister 술식의 치료 방법을 소개하고 그 결과를 알아보고자 하였다. 대상 및 방법: 14예의 환자를 대상으로 하였으며 Rockwood 제 3형이 11예, 5형이 3예 였고 환자의 평균나이는 45.2세 였다. 변형된 Phemister 술식에 원추인대 기능의 강화를 위한 봉합 나사못을 추가하여 수술하였다. 추시 기간은 평균 14개월이었으며 술 후 임상적 평가는 Weitzman 분류 및 VAS 점수와 Constant 점수, KSS 점수를 사용하였다. 결과: Weitzman 분류상 13예에서 우수, 1예에서 양호로 평가되었고 평균 관절 운동 범위는 전방거상 170.7도, 외전 166.4도, 외회전 68.2도, 내회전 T7 였다. 평균 VAS 점수는 1.9, 평균 Constant 점수는 90.8점, 평균 KSS 점수는 91점이었다. 방사선학적 평가 결과는 모든 예에서 양호한 결과를 얻었다. 결론: 견봉쇄골 관절의 급성 탈구에서 원추인대 기능의 강화를 위한 봉합 나사못을 추가한 변형된 Phemister 술식은 임상적으로 유용한 수술 방법으로 사료된다.

Purpose: The purpose of this study was to present methods and results for the modified Phemister operation, with a suture anchor added for augmentation of the conoid ligament in cases of acute dislocation of the acromioclavicular joint. Materials and Methods: We evaluated 14 cases of acute dislocation of the acromioclavicular joint. This included 11 cases of Rockwood type 3, and 3 cases of type 5. The mean age of patients was 45.2 years. We operated on them using an anchor for augmentation of the conoid ligament in the modified Phemister operation. The average follow-up period was 14 months and post-operative clinical analysis was conducted using the Weitzman classification, VAS Score, Constant Score and KSS Score. Results: According to Weitzman scores, 13 cases were evaluated as excellent, and one case was good. They had mean joint ranges of forward elevation of $170.7^{\circ}$, lateral elevation of 166.4, external rotation of 68.2, and internal rotation to the level of T7. The mean VAS Score was 1.9, mean Constant Score 90.8, and the mean KSS Score 91. Radiologic analysis indicated that all cases had a good result. Conclusion: The modified Phemister operation with a suture anchor added for augmentation of the conoid ligament is very effective clinically in acute dislocations of the acromioclavicular joint.

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참고문헌

  1. Boehm TD, Kirschner S, Fischer A, Gohlke F: The relation of the coracoclavicular ligament insertion to the acromioclavicular joint. A cadaver study of relevance to lateral clavicle resection. Acta Orthop Scand, 74: 718-721, 2003. https://doi.org/10.1080/00016470310018261
  2. Bosworth BM: Acromioclavicular separation: New methods of repair. Surg Gynecol Obstet, 73: 866-871, 1941.
  3. Breslow MJ, Jazrawi LM, Bernstein AD, Kummer FJ, Rokito AS: Treatment of acromioclavicular joint separation. suture or suture anchors? J Shoulder Elbow Surg, 11: 225-229, 2002. https://doi.org/10.1067/mse.2002.123904
  4. Chernchujit B, Tischer T, Imhoff AB: Arthroscopic reconstruction of the acromioclavicular joint disruption. Surgical technique and preliminary results. Arch Orthop Trauma Surg, 126: 575-581, 2006. https://doi.org/10.1007/s00402-005-0073-6
  5. Constant CR, Murley AH: A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res, 214: 160-164, 1987.
  6. Costic RS, Jari R, Rodosky MW, Debski RE: Joint compression alters the kinematics and loading patterns of the intact and capsule-transected AC joint. J Orthop Res, 21: 379-385, 2003. https://doi.org/10.1016/S0736-0266(02)00197-3
  7. Debski RE, Parsons IM 3rd, Fenwick J, Vangura A: Ligament mechanics during three degree-of-freedom motion at the acromioclavicular joint. Ann Biomed Eng, 28: 612-618, 2000. https://doi.org/10.1114/1.1304848
  8. Dimakopoulos P, Panagopoulos A, Syggelos SA, Panagiotopoulos E, Lambiris E: Double-loop suture repair for acute acromioclavicular joint disruption. Am J Sports Med, 34: 1112-1119, 2006. https://doi.org/10.1177/0363546505284187
  9. Fukuda K, Craig EV, An KN, Cofield RH, Chao EY: Biomechanical study of the ligamentous system of the acromioclavicular joint. J Bone Joint Surg Am, 68: 434-440, 1986.
  10. Haberneck H, Weinstabl R, Schmid L, Fialka C: A crook plate for treatment of acromioclavicular joint separation. Indication, technique and results after one year. J Trauma, 35: 893-901, 1993. https://doi.org/10.1097/00005373-199312000-00016
  11. Harris RI, Wallace AL, Harper GD, Goldberg JA, Sonnabend DH, Walsh WR: Structural properties of the intact and the reconstructed coracoclavicular ligament complex. Am J Sports Med, 28: 103-108, 2000.
  12. Hessmann M, Gotzen L, Gehling H: Acromioclavicular reconstruction augmented with polydioxanonsulphate bands. Surgical technique and results. Am J Sports Med, 23: 552-556, 1995. https://doi.org/10.1177/036354659502300506
  13. Jerosh J, Filler T, Peuker E, Greig M, Siewering U: Which stabilization technique corrects anatomy best in patients with AC-separation? An experimental study. Knee Surg Sports Traumatol Arthrosc, 7: 365-372, 1999. https://doi.org/10.1007/s001670050182
  14. Larsen E, Bjerg-Nielsen A, Christensen P: Conservative or surgical treatment of acromioclavicular dislocation. A prospective, controlled, randomized study. J Bone Joint Surg Am, 68: 552-555, 1986.
  15. Lee DJ, Park SR, Kim MK, et al.: Using suture anchors in the treatment of an acromioclavicular dislocation. J Korean Orthop Assoc, 41: 303-309, 2006.
  16. Lee KW, Debski RE, Chen CH, Woo SL, 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
  17. Lemos MJ: The evaluation and treatment of the injured acromioclavicular joint in athletes. Am J Sports Med, 26: 137-144, 1998.
  18. Lindsey RW, Gutowski WT: The migration of a broken pin following fixation of the acromioclavicular joint. A case report and review of the literature. Orthopedics, 9: 413-416, 1986.
  19. Mazzocca AD, Arciero RA, Bicos J: Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med, 35: 316-329, 2007. https://doi.org/10.1177/0363546506298022
  20. Mazzocca AD, Santangelo SA, Johnson ST, Rios CG, Dumonski ML, Arciero RA: A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med, 34: 236-246, 2006. https://doi.org/10.1177/0363546505281795
  21. McConnell AJ, Yoo DJ, Zdero R, Schemitsch EH, McKee MD: Methods of operative fixation of the acromioclavicular joint. A biomechanical comparison. J Orthop Trauma, 21: 248-253, 2007. https://doi.org/10.1097/BOT.0b013e31803eb14e
  22. Park JP, Arnold JA, Coker TP, Harris WD, Becker DA: Treatment of acromioclavicular separations. A retrospective study. Am J Sports Med, 8: 251-256, 1980. https://doi.org/10.1177/036354658000800407
  23. Pfahler M, Krodel A, Refior HJ: Surgical treatment of acromioclavicular dislocation. Arch Orthop Trauma Surg, 113: 308-311, 1994. https://doi.org/10.1007/BF00426177
  24. Phemister DB: The treatment of dislocation of the acromioclavicular joint by open reduction and threaded wire fixation. J Bone Joint Surg Am, 24: 166-168, 1942.
  25. Rockwood CA, Williams G, Young D: Disorders of the acromioclavicular joint. In: Rockwood CA, Matsen FA, Wirth M, Latsen LR, eds. The shoulder. Philadelphia, Penn, Saunders: 521-595, 2004.
  26. Shin SJ, Roh KJ, Jeong BJ: Coracoclavicular ligament reconstruction for acromioclavicular dislocation using two suture anchors and coracoacromial ligament transfer. J Korean Shoulder Elbow Soc, 11: 46-52, 2008. https://doi.org/10.5397/CiSE.2008.11.1.046
  27. Smith MJ, Stewart MJ: Acute acromioclavicular separations. A 20-year study. Am J Sports Med, 7: 62-71, 1979. https://doi.org/10.1177/036354657900700113
  28. Shin SJ, Tae SK, Rhee YG, et al.: The development and validation of an appraisal method for rotator cuff disorders: The Korean Shoulder Scoring System. J Shoulder Elbow Surg, 18: 689-696, 2009. https://doi.org/10.1016/j.jse.2008.11.019
  29. Chun CH, Lee SH, Lee BC, Cho YW: The Surgical Treatment of Acromioclavicular Joint Dislocation using Modified Phemister and Modified Weaver-Dunn Operation. J Shoulder Elbow Surg, 1: 180-185, 1998.
  30. Su EP, Vargas JH 3rd, Boynton MD: Using suture anchor for coracoclavicular fixation in treatment of complete acromioclavicular separation. Am J Orthop, 33: 256-257, 2004.
  31. Weitzman G: Treatment of acute acromioclavicular joint dislocation by a modified Bosworth method. Report on twenty-four cases. J Bone Joint Surg Am, 49: 1167-1178, 1967.