肩鎖関節脱臼に対するプレート固定法 －靭帯修復 • 再建は必要か－

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Background: Various surgical techniques have been reported for acromioclavicular joint (ACj) dislocation, with the clinical outcomes mostly being good to excellent. However, in practice, upward migration of the distal end of the clavicle is often noted after the removal of hook plate. The purpose of this retrospective study was to compare the radiographic outcomes of shoulders treated with hook plates. Methods: Sixty-one patients were surgically treated with hook plate. Preoperative dislocation after Rookwood's classification were Type III (35 patients), Type IV (4 patients), Type V (22 patients). They were divided into 3 groups as follows; Hook plate fixation only (38 patients), hook plate fixation with coracoclavicular (CC) ligament repair (18 patients), hook plate fixation with reconstruction of CC ligament (5 patients). The distance between the inferior margin of acromion and clavicle (AC distance) measured on A-P view of plain Xp before and at the final follow up were as follows. Results: AC distance of the 3 groups were as follows, hook plate fixation (13.4 ± 4.2mm before surgery and 1.5 ± 2.9mm at final follow up), hook plate fixation with the CC ligament repair (14.3 ± 4.8mm and 0.2 ± 1.1mm), hook plate fixation with CC ligament reconstruction (16.8 ± 5.6mm and 1.3 ± 2.1mm). The time to the hook plate removal was 16.4 ± 3.7 weeks in hook plate fixation only, 15.7 ± 4.1 weeks in hook plate fixation with the CC ligament repair, 15.3 ± 1.4 weeks in hook plate fixation with CC ligament reconstruction. There were two complications of bone erosions and distal end clavicle bone resorption. Conclusion: There was no significant difference between hook plate with or without ligament repair / reconstruction. However hook plate with ligament repair / reconstruction showed a tendency of less upward migration after plate removal.
日本肩関節学会の論文

肩鎖関節脱臼に対するプレート固定法<BR>－靭帯修復 • 再建は必要か－

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