肩鎖関節脱臼のエンドボタンを用いた手術法の問題点と対策

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Background: We reported a method for treating acromioclavicular(A-C) joint dislocation using two flip buttons and fiberwire in 2010. Now, we report about the problems of this method. Methods: We referred to MINAR(Minimally Invasive AC joint Repair) reported by Wellmann et al, and made an original drill guide using bent elevatrium. A 4.5-mm drill was used to create a pilot hole in the base of the coracoid. A fiberwire loop was threaded through the internal eyelets of a flip button. Then, the prepared flip button was pushed through the coracoid drill hole and placed under the coracoid base. One end of the flip button was then passed through a 4.5-mm drill hole placed through the clavicle in line with the base of the coracoid. Afterward, repositioning the clavicle end, the fiberwire loop was tied. Operation time is about 50 minutes. Using this method, we performed A-C reconstruction on 4 cases (all male, average age 31.5y.o.) Results: 2 cases had no pain, but there were sinking of flip buttons on the clavicles. Because 1 case suffered from deep infection, and cutting out of the flip button on the coraciod, we were forced to remove the flip buttons. We changed the size of flip button on the clavicle, and curve of the elevatrium. Conclusion: We concluded that this method for A-C joint dislocation using two flip buttons and fiberwire has problems and measures.
日本肩関節学会の論文