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봉합 나사못과 Kirschner 강선을 이용한 제 5형 급성 견봉 쇄골 관절 탈구의 수술적 치료

The Surgical Treatment of Type V Acute Acromioclavicular Joint Dislocation Using Suture Anchor and Kirschner Wire

  • 정구희 (고신대학교 복음병원 정형외과학교실) ;
  • 조철현 (계명대학교 의과대학 정형외과학교실) ;
  • 장수진 (고신대학교 복음병원 정형외과학교실) ;
  • 장재호 (고신대학교 복음병원 정형외과학교실) ;
  • 김재도 (고신대학교 복음병원 정형외과학교실)
  • Jung, Gu-Hee (Department of Orthopedic Surgery, Gospel Hospital, Kosin University) ;
  • Cho, Chyul-Hyun (Department of Orthopaedic Surgey, School of Medicine, Keimyung University) ;
  • Jang, Su-Jin (Department of Orthopedic Surgery, Gospel Hospital, Kosin University) ;
  • Jang, Jae-Ho (Department of Orthopedic Surgery, Gospel Hospital, Kosin University) ;
  • Kim, Jae-Do (Department of Orthopedic Surgery, Gospel Hospital, Kosin University)
  • 투고 : 2010.05.28
  • 심사 : 2010.11.30
  • 발행 : 2010.12.15

초록

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.

Purpose: We wanted to evaluate the clinical outcomes after operative treatment using two suture anchors and Kirschner wire for treating acute Rockwood type V acromioclavicular joint dislocation Materials and Methods: Between May 2006 and May 2009, 10 patients underwent surgical treatment for acute Rockwood type V acromioclavicular joint dislocation using two suture anchors and Kirschner wire and they were followed for a mean of 12.0 (range: 7-31) months. We analyzed the functional results by the Korean shoulder score, the Constant-Murley score and the reduction state of the acromioclavicular joint at the last follow-up. Results: All the cases achieved a satisfactory outcome. The mean Korean shoulder score was 89.9 (range: 81-100) points and the mean Constant-Murley score was 87.8 (range: 82-93) points. According to the radiologic findings, 8 patients achieved anatomical reduction of the acromioclavicular joint: there was a slight loss of reduction in one patient and a partial loss of reduction in one patient. None of the patients had deep infection or re-dislocation. Conclusion: The operative treatment using two suture anchors and Kirschner wire may be used for acute Rockwood type V acromioclavicular joint dislocation, and it has an advantage in that it can prevent chondral injury of the joint.

키워드

참고문헌

  1. 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
  2. Chimich D, Frank C, Shrive N, Dougall H, Bray R: The effects of initial end contact on medial collateral ligament healing: a morphological and biomechanical study in a rabbit model. J Orthop Res, 9: 37-47, 1991. https://doi.org/10.1002/jor.1100090106
  3. Cho NS, Yi JW, Lee BG, Rhee YG: Revision open Bankart surgery after arthroscopic repair for traumatic anterior shoulder instability. Am J Sports Med, 37: 2158-2164, 2009. https://doi.org/10.1177/0363546509339015
  4. Chun JM, Kim SY, Choi JH, Kim TS, Kim KY: Surgical treatment of the acute acromioclavicular joint dislocation using a Wolter plate. J Korean Orthop Assoc, 37: 185-190, 2002.
  5. Chun JM, Kim SY, Lee KW, Shin SJ, Kim EG: Modified tension band fixation for unstable fracture of the distal clavicle. J Korean Orthop Assoc, 37: 416-420, 2002.
  6. Dumontier C, Sautet A, Man M, 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
  7. Goble EM, Somers WK, Clark R, Olsen RE: The development of suture anchors for use in soft tissue fixation to bone. Am J Sports Med, 22: 236-239, 1994. https://doi.org/10.1177/036354659402200214
  8. Habernek 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
  9. Koukakis A, Manouras A, Apostolou CD, Lagoudianakis E, Papadima A, Triantafillou C, et al.: Results using the AO hook plate for dislocations of the acromioclavicular joint. Expert Rev Med Devices, 5: 567-572, 2008. https://doi.org/10.1586/17434440.5.5.567
  10. Kwon YW, Iannotti JP: Operative treatment of acromioclavicular joint injuries and results. Clin Sports Med, 22: 291-300, 2003. https://doi.org/10.1016/S0278-5919(03)00005-X
  11. Lee KW, Choi YJ, Ahn HS, Kim CH, Hwang JK, Han HD, et al.: Treatment of the acromioclavicular joint dislocation using a AO hook plate. J Korean Shoulder Elbow Soc, 12: 167-172, 2009. https://doi.org/10.5397/CiSE.2009.12.2.167
  12. Lizaur A, Marco L, Cebrian R: Acute dislocation of the acromioclavicular joint. Traumatic anatomy and the importance of deltoid and trapezius. J Bone Joint Surg Br, 76: 602-606, 1994.
  13. Loitz-Ramage BJ, Frank CB, Shrive NG: Injury size affects long-term strength of the rabbit medial collateral ligament. Clin Orthop Relat Res, 337: 272-280, 1997. https://doi.org/10.1097/00003086-199704000-00031
  14. Macdonald PB, Lapointe P: Acromioclavicular and sternoclavicular joint injuries. Orthop Clin North Am, 39: 535-45, 2008. https://doi.org/10.1016/j.ocl.2008.05.003
  15. 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
  16. Morrison DS, Lemos MJ: Acromioclavicular separation. Reconstruction using synthetic loop augmentation. Am J Sports Med, 23: 105-110, 1995. https://doi.org/10.1177/036354659502300118
  17. Nuber GW, Bowen MK: Acromioclavicular Joint Injuries and Distal Clavicle Fractures. J Am Acad Orthop Surg, 5: 11-18, 1997.
  18. Rios CG, Arciero RA, Mazzocca AD: Anatomy of the clavicle and coracoid process for reconstruction of the coracoclavicular ligaments. Am J Sports Med, 35: 811-817, 2007. https://doi.org/10.1177/0363546506297536
  19. Rockwood CA Jr, Williams GR Jr, Young DC: Disorder of the acromioclavicular joint. Rockwood CA Jr, Matsen FA III, editors. The Shoulder. 2nd. Philadelphia, WB Saunders: 483-553, 1998.
  20. Salem KH, Schmelz A: Treatment of Tossy III acromioclavicular joint injuries using hook plates and ligament suture. J Orthop Trauma, 23: 565-569, 2009. https://doi.org/10.1097/BOT.0b013e3181971b38
  21. Shin SJ, Yun YH, Yoo JD: Coracoclavicular ligament reconstruction for acromioclavicular dislocation using 2 suture anchors and coracoacromial ligament transfer. Am J Sports Med, 37: 346-351, 2009. https://doi.org/10.1177/0363546508324968
  22. Sim E, Schwarz N, Hocker K, Berzlanovich A: Repair of complete acromioclavicular separations using the acromioclavicular-hook plate. Clin Orthop Relat Res, 314: 134-142, 1995.
  23. Taft TN, Wilson FC, Oglesby JW: Dislocation of the acromioclavicular joint. An end-result study. J Bone Joint Surg Am, 69: 1045-1051, 1987.
  24. Williams GR Jr, Nguyen VD, Rockwood CA Jr: Classification and radiographic analysis of acromioclavicular dislocations. Appl Radiol, 18: 29-34, 1989.
  25. Woo SL, Buckwalter JA: Ligaments. DeLee JC, Drez D, Miller MD, editors. Orthopaedic sports medicine. Philadelphia, Saunders: 39-49, 2003.