Clinics in Shoulder and Elbow

대한견·주관절의학회 (Korean Shoulder and Elbow Society)
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Tight-Rope®을 이용한 급성 견봉 쇄골 관절 탈구의 치료 - 예비 보고 -

Coracoclavicular Ligament Augmentation Using Tight-Rope® for Acute Acromioclavicular Joint Dislocation - Preliminary Report -

  • 권석현 (원광대학교 의과대학 정형외과학교실) ;
  • 최상수 (원광대학교 의과대학 정형외과학교실) ;
  • 이성인 (원광대학교 의과대학 정형외과학교실) ;
  • 김정우 (원광대학교 의과대학 정형외과학교실) ;
  • 김광미 (초당대학교 간호학교실)
  • Kweon, Seok Hyun (Department of Orthopaedic Surgery, Wonkwang University School of Medicine) ;
  • Choi, Sang Su (Department of Orthopaedic Surgery, Wonkwang University School of Medicine) ;
  • Lee, Seong In (Department of Orthopaedic Surgery, Wonkwang University School of Medicine) ;
  • Kim, Jeong Woo (Department of Orthopaedic Surgery, Wonkwang University School of Medicine) ;
  • Kim, Kwang Mee (Department of Nursing Science, Chodang University Muan)
  • 투고 : 2012.09.24
  • 심사 : 2013.11.09
  • 발행 : 2013.12.31
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초록

목적: 급성 견봉 쇄골 관절 탈구에서 Tight-Rope$^{(R)}$ (Arthrex)를 이용한 오구 쇄골 인대 보강술의 유용성을 알아보고자 하였다. 대상 및 방법: 2009년 10월부터 2011년 3월까지 급성 견봉 쇄골 관절 탈구 환자에 대해 Tight-Rope$^{(R)}$를 이용하여 치료한 환자 중에서 12개월 이상 추시 관찰이 가능한 30명을 대상으로 하였다. 술 후 정복 상태의 평가는 쇄골의 방사선학적 추시를 통해 분석하였으며 임상적 결과는 UCLA 점수, Constant 점수 및 VAS 통증 점수를 사용하였다. 결과: 임상적 평가에서 UCLA 점수는 22예(73%)에서 우수, 5예(17%)에서 양호, 2예(7%)에서 보통, 1예(3%)에서 불량이었으며, Constant 점수는 평균 $92.5{\pm}7.5$점이었다. 방사선학적 결과는 26예(86%)에서 해부학적 정복을 보였으며, 2예(7%)에서 중등도의 정복 소실, 2예(7%)에서 완전 재탈구를 보였으며, 이중 완전 재탈구를 보였던 2예에서 임상적 결과가 만족스럽지 않았으며 재수술을 필요로 하였다. 결론: 급성 견봉 쇄골 관절 탈구에서 Tight-Rope$^{(R)}$를 이용한 오구 쇄골 인대 보강술은 신뢰할 만한 임상적 결과를 제공하는 좋은 치료 방법이라 생각한다.

Purpose: The purpose of this study is to analyze the results of acute acromioclavicular joint dislocation treatment with coracoclavicular ligament augmentation using Tight-Rope$^{(R)}$ (Arthrex). Materials and Methods: From October 2009 to March 2011, 30 patients with acute acromioclavicular joint dislocation underwent coracoclavicular ligament augmentation using Tight-Rope$^{(R)}$ and were followed up for at least 12 months after surgery. The radiologic results were qualified according to serial plain radiographs, and the clinical results according to University of California - Los Angeles (UCLA) Shoulder Scale, Constant score, and VAS pain score. Results: Using the UCLA scoring system, excellent results were observed in 22 cases (73%), good results in five cases (17%), fair results in two cases (7%), and a poor result in one case (3%). The average Constant score was $92.5{\pm}7.5$. According to radiologic results, anatomical reduction was achieved in 26 cases, and two cases showed a moderate loss of reduction, and two cases showed complete re-dislocation. Clinical results for patients with re-dislocation were unsatisfactory and reoperation was required. Conclusion: Coracoclavicular ligament augmentation using Tight-Rope$^{(R)}$ is a good option providing reliable functional results in patients with acute acromioclavicular joint dislocation.

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참고문헌

  1. Allman FL Jr. Fracture and ligamentous injures of the clavicle and its articulation. J Bone Joint Surg Am. 1967;49:774-84. https://doi.org/10.2106/00004623-196749040-00024
  2. Galatz LM, Willams GR. Acromioclavicular joint injuries. In: Bucholz RW, Heckman JD, eds. Rockwood and Green's Fractures in Adults. Vol 2. 5th ed. Philladelphia, PA: Lippincott Willams & Wilkins;2001.1209-40.
  3. Mazzocca AC, Santangelo SA, Johnson ST, Rios CG, Dumonski ML, Arciero RA. A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med. 2006;34:236-46. https://doi.org/10.1177/0363546505281795
  4. Gurtter PW, Petersen SA. Conservative or surgical treatment of acromioclavicular dislocation. A prospective, controlled, randomized study. Am J Sports Med. 2005;33:1723-8. https://doi.org/10.1177/0363546505275646
  5. Larsen E, Bjerg-Nielsen A, Christensen P. Conservative or surgical treatment of acromioclavicular dislocation. A prospective, controlled, randomized study. J Bone Joint Surg Am. 1986;68:552-5. https://doi.org/10.2106/00004623-198668040-00011
  6. Baumgarten KM. Arthroscopic fixation of a type IIvariant, unstable distal clavicle fracture. Orthopedics. 2008;31:1-3.
  7. Cho CH, Sohn SW, Kang CH, Oh GM. Coracoclavicular ligament augmentation using Tight-Rope􀋓 for acute acromioclavicular joint dislocation: surgical technique and preliminary results. J Korean Shoulder Elbow Soc. 2008;11:165-71. https://doi.org/10.5397/CiSE.2008.11.2.165
  8. Choi ES, Park KJ, Kim YM, et al. Arthroscopic treatment of acromioclavicular joint dislocation using $Tight-Rope^{(R)}$: preliminary results. J Korean Fracture Soc. 2010;23:310-6. https://doi.org/10.12671/jkfs.2010.23.3.310
  9. Murena L, Vulcano E, Ratti C, Cecconello L, Rolla PR, Surace MF. Arthroscopic treatment of acute acromioclavicular joint dislocation with double flip button. Knee Surg Sports Traumatol Arthrosc. 2009;17:1511-5. https://doi.org/10.1007/s00167-009-0838-5
  10. Robinson CM, Akhtar MA, Jenkins PJ, Sharpe T, Ray A, Olabi B. Open reduction and Endobutton fixation of displaced fracture of lateral end of the clavicle in younger patients. J Bone Joint Surg Br. 2010; 92:811-6.
  11. Zooker CC, Parks BG, White KL, Hinton RY. Tight-Rope versus fiber mesh tape augmentation of acromioclavicular joint reconstruction: a biomechanical study. Am J Sports Med. 2010;38:1204-8. https://doi.org/10.1177/0363546509359064
  12. Struhl S. Double Endobutton technique for repair of complete acromioclavicular joint dislocations. Tech Shoulder Elbow Surg. 2007;8:175-9. https://doi.org/10.1097/BTE.0b013e31815907a3
  13. Ball SV, Sankey A, Cobiella C. Clavicle fracture following Tight-Rope fixation of acromioclavicular joint dislocation. Injury Extra. 2007;38:430-2. https://doi.org/10.1016/j.injury.2007.02.036
  14. Lim YW, Sood A, van Riet R P, Bain GI. Acromioclavicular joint reduction, repair and reconstruction using metallic buttons - early results and complications. Tech Shoulder Elbow Surg. 2007;8:213-21. https://doi.org/10.1097/BTE.0b013e3181578965
  15. Chernchujit B, Tischer T, Imhoff AB. Arthroscopic reconstruction of the acromioclavicular joint disruption: surgical technique and preliminary results. Arch Orthop Trauma Surg. 2006;126:575-81. https://doi.org/10.1007/s00402-005-0073-6
  16. Lancaster S, Horowitz M, Alonso J. Complete acromioclavicular separations. A comparison of operative methods. Clin Orthop Relat Res. 1987;216:80-8.
  17. 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. 1986;68:434-40. https://doi.org/10.2106/00004623-198668030-00019
  18. Klimkiewicz JJ, Williams GR, Sher JS, Karduna A, Des Jardins J, Iannotti JP. The acromioclavicular capsule as a restraint to posterior translation of the clavicle: a biomechanical analysis. J Shoulder Elbow Surg. 1999;8:119-24. https://doi.org/10.1016/S1058-2746(99)90003-4
  19. Lemos MJ. The evaluation and treatment of the injured acromioclavicular joint in athletes. Am J Sports Med. 1998;26:137-44. https://doi.org/10.1177/03635465980260010801
  20. Bearden JM, Hughston JC, Whatley GS. Acromioclavicular dislocation: method of treatment. J Sports Med. 1973;1:5-17.
  21. Neviaser JS. 7 Acromioclavicular dislocation treated by transference of the coraco-acromial ligament: A long-term follow-up in a series of 112 cases. Clin Orthop Relat Res. 1968;58:57-68.
  22. Weaver JK, Dunn HK. Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg. 1972;54:1187-94. https://doi.org/10.2106/00004623-197254060-00005
  23. Dewar FP, Barrington TW. The treatment of chronic acromioclavicular dislocation. J Bone Joint Surg Am. 1965;47:32-5.
  24. Weizman G. Treatment of acute acromioclavicular joint dislocation by a modified Bosworth method. J Bone Joint Surg Am. 1967;49:1167-78. https://doi.org/10.2106/00004623-196749060-00014
  25. Shin SJ, Roh KJ, Kim JO, Sohn HS. Treatment of unstable distal clavicle fractures using two suture anchors and suture tension bands. Injury. 2009;40:1308-12. https://doi.org/10.1016/j.injury.2009.03.013
  26. Khan LA, Bradnock TJ, Scott C, Robinson CM. Fractures of the clavicle. J Bone Joint Surg Am. 2009;91:447-60. https://doi.org/10.2106/JBJS.H.00034
  27. Yamaguchi H, Arakawa H, Kobayashi M. Results of the Bosworth method for unstable fractures of the distal clavicle. Int Orthop. 1998;22:366-8. https://doi.org/10.1007/s002640050279
  28. Wellmann M, Zantop T, Peterson W. Minimally invasive coracoclavucular ligament augmentation with flip button/polydioxanon repair for treatment of total acromioclavicular joint dislocation. Arthroscopy, 2007;23:1132 e1-5.
  29. Lim YW. Triple Endobutton technique in acromioclavucular joint reduction and reconstruction. Ann Acad Med. 2008;37:294-9.
  30. Jari R, Costic RS, Rodosky MW, Debski RE. Biomecchanical function of surgical procedures for acromioclavicular joint dislocations. Arthroscopy. 2004;20:237-45. https://doi.org/10.1016/j.arthro.2004.01.011
  31. Debski RE, Parsons IM III, Fenwick J, Vangura A. Ligament mechanics during three degree-of-freedom motion at the acromioclavicular joint. Ann Biomed Eng. 2000;28:612-8. https://doi.org/10.1114/1.1304848