• Clinics in Shoulder and Elbow
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• 제2권1호
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• pp.1-7
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• 1999

Purpose : There has been considerable controversy as to the method of the treatment of acute acromioclavicular joint dislocation classified to type III injury. The purpose of this study is to compare the conservative and operative treatment of the type III acute acromioclavicular joint dislocation in terms of clinical and radiological results. Materials and Methods: We treated 31 cases of acute, type III acromioclavicular joint dislocation, 17 cases were treated by operative methods and 14 patients by conservative treatment, and 1 year minimum follow-up was done from January 1990 to January 1996. We used UCLA Shoulder Rating Scale for clinical results. And for the radiological results coracoclaviclar distance were measured. We used Fisher's exact test for statistical analysis of results between the two treatment methods. Results: Fifteen(88.2%) of seventeen patients in operative treatment and eleven(78.6%) of fourteen patients in nonoperative treatment were rated excellent or good on the UCLA rating scale. In radiographic evaluation, the average coracoclavicular distances of preoperative state, immediate postoperation(or postreduction) and last follow-up were as follows. In operative cases, it was 1.75±0.21mm, 1.14±0.24mm and 1.33± 0.22mm respectively. In nonoperative cases, it was 1.65±0.14mm, 1.26±0.26mm, and 1.42±0.27mm respectively. Conclusion : This study demonstrated that there was no significant difference in clinical and radiological results between the operative and nonoperative treatment groups. So, nonoperative treatment is recommended for acute type III acromioclavicular dislocation as general rule.

• Clinics in Shoulder and Elbow
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• 제22권2호
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• pp.93-99
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• 2019

Background: Modified Phemister operation has been widely used for the treatment of acute acromioclavicular (AC) joint dislocation. Additionally, the use of suture anchor for coracoclavicular (CC) fixation has been reported to provide CC stability. This study was conducted to evaluate the clinical and radiological results of a modified Phemister operation with CC ligament augmentation using suture anchor for acute AC joint dislocation. Methods: Seventy-four patients underwent the modified Phemister operation with CC ligament augmentation using suture anchor for acute AC joint dislocation and were followed-up for an average of 12.3 months. The visual analogue scale (VAS), range of motion, Constant score, and Korean shoulder scoring system (KSS) were used for clinical assessment. Acromioclavicular interval (ACI), coracoclavicular distance (CCD), and acromioclavicular distance (ACD) were obtained to evaluate the radiological assessments. Results: At the last follow-up, the mean VAS Score was 1.7 points, the mean joint range of the forward flexion was $164.6^{\circ}$, external rotation at the side was $61.2^{\circ}$ and internal rotation to the posterior was a level of T12. The mean Constant score and the mean KSS was 82.7 points and 84.2 points, respectively. At the mean ACI, CCD, and ACD, significant differences were found preoperatively and at the last follow-up. When the ACI, CCD, and ACD were compared with the contralateral unaffected shoulder at the last follow-up, the affected shoulders had significantly higher values. Conclusions: The modified Phemister operation with CC ligament augmentation using suture anchor is clinically and radiologically effective at acute AC joint dislocation.

• Clinics in Shoulder and Elbow
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• 제8권2호
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• pp.135-140
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• 2005

Purpose: To find out the early results after surgical treatment of the acute acromioclavicular dislocation with LIGASTIC artificial ligament. Material and Method: 6 patients who were diagnosed as acute acomioclavicular joint dislocation and treated with LIGASTIC artifical ligament through March 2005 to July 2005. The radiologic and clinical results using Imatani evaluation system were analyzed. Results: By clinical evaluation, 4 cases(67%) were excellent and 2 cases(33%) were good. By radiologic evaluation, 3 cases(50%) were excellent and 3 cases(50%) were good. All cases showed satisfactory results. Till the final follow up, there were no complication. Conclusion: Surgical treatment of the acute acromioclavicular dislocation with LIGASTIC articifial ligament is simple, but provides enough stability for early postoperative rehabilitation, decreases arthritis of acomioclavicular joint and there is no burden of removal of the fixture, so it is thought as a very effective surgery.

• Clinics in Shoulder and Elbow
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• 제23권3호
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• pp.159-165
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• 2020

Acromioclavicular (AC) joint dislocations account for about 9% of shoulder injuries. Among them, acute high-grade injury following high-energy trauma accounts for a large proportion of patients requiring surgical treatment. However, there is no gold standard procedure for operative treatment of acute high-grade AC joint injury, and several different procedures have been used for this purpose in clinical practice. This review article summarizes the most recent and relevant surgical options for acute high-grade AC joint dislocation patients and the outcomes of each treatment type.

• Clinics in Shoulder and Elbow
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• 제13권2호
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• pp.217-222
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• 2010

목적: Rockwood 제 5형 견봉 쇄골 관절 탈구에서 두개의 봉합 나사못 및 Kirschner 강선을 이용한 수술적 치료의 임상적 결과에 대해 알아보고자 하였다. 대상 및 방법: 2006년 5월부터 2009년 5월까지 두개의 봉합 나사못 및 Kirschner 강선을 이용하여 수술적 치료를 시행한 Rockwood 제 5형 견봉 쇄골 관절 탈구 10예를 대상으로 하였으며, 평균 추시 기간은 12.0 (7~31)개월 이였다. 한국 견관절 점수와 Constant-Murley 점수로써 임상적 평가를 시행하였으며, 단순 방사선 사진에서 견봉 쇄골 관절의 정복 상태를 측정하였다. 결과: 전 예에서 대부분 회복되어 만족할만한 임상적 결과를 얻었으며, 한국 견관절 점수는 평균 89.9 (81~100)점이고 Constant-Murley 점수는 평균 87.8 (82~93)점 이였다. 방사선학적으로 해부학적 정복이 8예, 경도의 정복 소실 1예, 중등도의 정복 소실이 1예였으며, 심부 감염이나 재탈구 등의 합병증은 발생하지 않았다. 결론: Rockwood 제 5형 견봉 쇄골 관절 탈구에서 두 개의 봉합 나사못 및 Kirschner 강선을 이용한 수술적 치료를 통해 만족할 만한 결과를 얻을 수 있었으며, 견봉 쇄골 관절을 통과하지 않은 K-강선 고정술을 시행함으로써 관절 연골에 대한 추가적인 손상을 예방할 수 있었다.

• Clinics in Shoulder and Elbow
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• 제22권3호
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• pp.149-153
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• 2019

We experienced acromial erosion and subsequent fracture after the treatment of Rockwood type V acromioclavicular dislocation with hook plate and coracoclavicular ligament augmentation. It was treated by using a surgical technique to address an acromial fracture and subsequent losses of reduction in acromioclavicular joint with two trans-acromial cortical screws (crossbar technique). The reduction state of acromioclavicular joint could be maintained by these two screws. Our crossbar technique could be considered as a good salvage procedure for the reduction loss caused by cutout or significant erosion of acromion after insertion of clavicular hook plate.

• Clinics in Shoulder and Elbow
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• 제16권2호
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• pp.115-122
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• 2013

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.

• Clinics in Shoulder and Elbow
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• 제17권4호
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• pp.159-165
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• 2014

Background: Kirschner's wire (K-wire) transfixation and locking hook plate fixation techniques are widely used in the treatment of acute acromioclavicular joint (ACJ) dislocation. The purpose of this study was to compare the clinical and radiologic outcomes between K-wires transfixation and a locking hook plate fixation technique. Methods: Seventy-seven patients with acute ACJ dislocation managed with K-wire (56 shoulders) and locking hook plate (21 shoulders) were enrolled for this study. The mean follow-up period was 61 months. Results: At the last follow-up, the shoulder rating scale of the University of California at Los Angeles (UCLA) was higher in patients treated with locking hook plate than with K-wires ($33.2{\pm}2.7$ vs. $31.3{\pm}3.4$, p=0.009). In radiologic assessments, coracoclavicular distance (CCD) (7.9 mm vs. 7.7 mm, p=0.269) and acromioclavicular distance (ACD) (3.0 mm vs. 1.9 mm, p=0.082) were not statistically different from contralateral unaffected shoulder in locking hook plate fixation group, but acromioclavicular interval (ACI) was significant difference. However, there were significant differences in ACI, CCD, and ACD in K-wire fixation group (p<0.001). Eleven complications (20%) occurred in K-wire transfixation group and 2 subacromial erosions on computed tomography scan occurred in locking hook plate fixation group. Conclusions: ACJ stabilization was achieved in acute ACJ dislocations treated with K-wires or locking hook plates. Locking hook plate can provide higher UCLA shoulder score than K-wire and maintain CCD, and ACD without ligament reconstruction. K-wire transfixation technique resulted in a higher complication rate than locking hook plate.

• Clinics in Shoulder and Elbow
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• 제13권1호
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• pp.34-39
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• 2010

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.

• Clinics in Shoulder and Elbow
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• 제11권2호
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• pp.165-171
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• 2008

목적: 급성 견봉 쇄골 관절 탈구에서 TightRope$^{(R)}$를 이용한 수술 술기를 소개하고 유용성 및 예비 결과를 알아보고자 한다. 대상 및 방법: 총 10예를 대상으로 하였으며, 평균 추시 기간은 12.4(8~16)개월이었다. 견봉 쇄골 관절의 내측 1 cm 부위에서 오구돌기 방향으로 4 cm의 피부 절개를 가하여 삼각근을 분리한 후 TightRope$^{(R)}$를 이용하여 오구 쇄골 인대 강화술을 시행하였으며, 술후 안정성을 주기 위해 2개의 1.6 mm K-강선을 이용하여 일시적인 견봉 쇄골 관절 고정술을 시행하였다. 방사선학적 평가는 단순 방사선 사진을 이용하였고, 임상적 평가는 UCLA 평가 점수를 이용하였다. 결과: 방사선학적 평가에서는 해부학적 정복이 7예, 경도의 정복 소실이 2예, 중등도의정복 소실이 1예였다. UCLA 점수는 평균 30.8(24~35)점으로 우수 6예, 양호 3예, 보통 1예였다. 결론: 급성 견봉 쇄골 관절 탈구에서 TightRope$^{(R)}$를 이용한 치료는 최소 침습적이며, 비교적 술기가 간편하고 안정된 고정을 얻을 수 있는 방법으로 생각된다. 그러나 정확한 결과 분석을 위해서는 장기 추시 관찰이 필요할 것으로 사료된다.