肩鎖関節脱臼に対する Phemister 変法（4 in 1 procedure）による治療成績

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Our modified Phemister procedure (4 in 1 procedure) composed of coracoclavicular ligament repair, Kirschner wire fixation of the acromioclavicular joint, acromioclavicular ligament repair and overlapped suture of deltoid and trapezium muscle in 1 incision. Kirschner wires were removed between 8 and 10 weeks after the surgery. The purpose of this study was to investigate the results of our 4 in 1 procedure for acromioclavicular dislocation. 37 cases with Rockwood classification Types III to V acromioclavicular dislocation had been operated at Saiseikai Kanagawaken Hospital and Shizuoka Red Cross Hospital from 2000 to 2006. The average age at operation was 39.6 years old (17 - 63 years old). The clinical results were evaluated by the Japan Shoulder Society (JSS) score for acromioclavicular dislocation. Using anteroposterior roentgenographic views, rates of acromioclavicular dislocation, coraco-clavicular distances, acromioclavicular osteoarthritis and ossification of the coracoclavicular ligament were evaluated. These factors were examined statistically by using nonparametric tests. The postoperative JSS scores (Type III/Type IV/Type V) were 97.8(93-100)/86.0(82-90)/95.9(82-100)(p>0.05). Acromioclavicular dislocation rates (Type III /Type IV/Type V) after the removal of K-wires were 6.89 % (0-22.2)/28.6% (0-57.1)/32.5%(0-83.3)(p>0.05). Coracoclavicular distances(Type III/Type IV/Type V) after the removal of K-wires were 85.7%(30.0-125)/133%(85.7-180)/141%(57.1-257)(p>0.05). Ossification of coracoclavicular ligament (Type III/Type IV/Type V) were observed 16.7%/50.0%/44.8% (p>0.05). Acromioclavicular osteoarthritis (Type III/Type IV/Type V) were observed 33.3 %/50.0%/34.5% (p>0.05). The clinical results of 4 in 1 procedure were satisfactory. But there is necessity to reconsider the term, the location and the technique of K-wire fixation.
日本肩関節学会の論文

肩鎖関節脱臼に対する Phemister 変法（4 in 1 procedure）による治療成績

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