견봉 쇄골 관절 탈구의 관혈적 정복술시 오구 쇄골 인대 봉합의 필요성

국문 초록 (Abstract)

목적: 오구 쇄골 인대를 봉합하지 않고 견봉 쇄골 관절의 관혈적 정복만 시행한 환자군에서의 임상적, 방사선학적 추시 결과를 확인하고자 하였다.
대상 및 방법: 1998년부터 2007년까지 변형 Phemister 술식과 갈고리 금속판 (AO hook 금속판, Wolter 금속판)을 사용하여 견봉 쇄골 관절 탈구로 수술 받은 환자 중 삽입물 제거한 53예를 대상으로 하였다. 변형 Phemister 술식을 사용한 군이 21명, 갈고리 금속판을 사용한 군이 32명 이였다. 임상적 평가는 Constant score를 이용하였으며, 양측 쇄골과 오구돌기 사이의 수직거리를 비교하여 방사선적 평가를 하였다.
결과: Constant score는 변형 Phemister 술식을 사용한 군에서는 87.59±7.8, 갈고리 금속판을 사용한 군에서는 89.35±5.3로 통계학적 차이는 없었다. 두 군에서 수술 전 손상 부위의 쇄골 오구돌기의 평균 거리는 15.9 mm 이였으며, 건측 견관절은 평균 8.0 mm 이였다. 갈고리 금속판 환자군에서 건측과 비교하여 평균 1.0 mm, 변형 Phemister 환자군에서는 평균 1.2 mm 의 수직 전위가 관찰되었으며 통계학적 차이는 없었다.
결론: 오구쇄골 인대를 복원 하지 않은 견봉 쇄골 관절 탈구의 관혈적 정복술 및 내고정술은 양호한 임상적, 방사선학적 결과를 보였다.

다국어 초록 (Multilingual Abstract)

Purpose: We evaluated clinical and radiological results for open reduction and internal fixation of acromioclavicular dislocation without coracoclavicular ligament repair after removal of implants.
Materials and methods: Clinical and radiological results were obtained for 53 patients who underwent open reduction and internal fixation of an acromioclavicular joint dislocation between 1998 and 2007. A total of 21 patients were treated with a modified-Phemister method and 32 patients were treated with a Hook plate method. All subjects were surveyed after removal of their implants. The Constant scoring system was administered postoperatively to evaluate clinical results. Radiologic outcomes were evaluated by both coracoclavicular intervals on plain films.
Results: Constant scores were 87.59±7.8 in the Phemister group and 89.35±5.3 in the Hook plate group. For both groups, the mean coracoclavicular interval at preoperative radiography was 15.9 mm at the injured site and 8.0 mm at the opposite site. After metal removal, the mean difference between coracoclavicular distances between normal and injured sites were 1.0 mm for the Hook plate group and 1.2 mm for the modified Phemister method group (p>0.05).
Conclusion: Open reduction and internal fixation of an acromioclavicular joint without coracoclavicular ligament repair shows good long-term clinical and radiological results.

목차 (Table of Contents)

• 서론
• 연구 대상 및 방법
• 결과
• 고찰
• 결론
• REFFERENCES
• 초록

참고문헌 (Reference)

1 김유진, "견봉-쇄골 관절 탈구에서 긴장대 강선을 이용한 Phemister 변형 술식" 대한골절학회 19 (19): 5-5, 2006

2 신상진, "견봉 쇄골 탈구의 수술적 치료: 오구 쇄골 인대의 재건" 대한골절학회 21 (21): 70-76, 2008

3 전재명, "Wolter식 금속판을 이용한 급성 견봉쇄골 관절 탈구의 수술적 치료" 대한정형외과학회 37 (37): 22-, 2002

4 최장석, "Wolter 금속판을 이용한 견봉 쇄골 관절 탈구의 수술적 치료 결과 및 술중 오구 쇄골 인대 봉합술의 임상적 유의성" 대한골절학회 19 (19): 8-8, 2006

5 강기서, "Wolter 금속판을 이용한 견봉 쇄골 관절 탈구 치료의 장기 추시 결과" 대한골절학회 22 (22): 259-263, 2009

6 Su EP, "Using suture anchors for coracoclavicular fixation in treatment of complete acromioclavicular separation" 33 : 256-257, 2004

7 Breslow MJ, "Treatment of acromioclavicular joint separation; suture or suture anchor" 11 : 225-229, 2002

8 Faraj AA, "The use of a hook-plate in the management of acromioclavicular injuries. Report of ten cases" 67 : 448-451, 2001

9 Phemister DB, "The treatment of dislocation of the acromioclavicular joint by the open reduction and threaded-wire fixation" 24 : 166-169, 1942

10 Thierry De Baets, "The treatment of acromioclavicular joint dislocation Tossy grade III with a clavicle hook plate" 70 : 515-519, 2004

11 Cook FF, "The Mumford procedure in athletes. An objective analysis of function" 16 : 97-100, 1988

12 Fumiki M, "Surgical treatment of comminuted fracture of the distal clavicle using Wolter clavicular plates" 67 : 32-34, 2000

13 Verhaven E, "Surgical treatment of acute type-V acromioclavicular injuries in athletes" 112 : 189-192, 1993

14 Meeder PJ, "Surgical repair of complete acromioclavicular separation (Tossy III) by tension wire bending and suture of the ligaments" 350 : 169-173, 1980

15 Koukakis A, "Results using the AO hook plate for dislocations of the acromioclavicular joint" 5 : 567-572, 2008

16 Wolter D, "Reposition and fixation of acromioclavicular luxation using a hooked plate" 170 : 80-86, 1984

17 Ernst S, "Repair of complete acromioclavicular separations using the acromioclavicular-hook plate" 314 : 134-142, 1995

18 Sim E, "Repair of complete acromioclavicular separations using the acromioclavicular separations using the acromioclavicular hook plate" 314 : 134-142, 1995

19 Ko SH, "Minimal incision Wolter plate fixation on the displaced lateral end fracture of the clavicle and the acromioclavicular dislocation" 5 : 23-28, 2002

20 Allman FL Jr, "Fractures and ligamentous injuries of the clavicle and its articulation" 49 : 774-784, 1967

21 Rockwood C, "Disorders of the acromioclavicular joint. In: The shoulder" Saunders 521-595, 2004

22 Rockwood CA, "Disorders of the acromioclavicular joint. In : The shoulder. 1st ed" WB Saunders Co 413-476, 1990

23 Bosworth BM, "Complete acromioclavicular dislocation" 241 : 221-225, 1949

24 Chun CH, "Clinical analysis of the acromioclavicular dislocation treated with modified Phemister method" 27 : 1052-1059, 1992

25 Shoji H, "Bone block transfer of coracoacromial ligament in acromioclavicular injury" 208 : 272-277, 1986

26 Lizaur A, "Acute dislocation of the acromioclavicular joint. Traumatic anatomy and the importance of deltoid and trapezius" 76 : 602-606, 1994

27 Hessmann M, "Acromioclavicular reconstruction augmented with polydioxanonsulphate bands. Surgical technique and results" 23 : 552-556, 1995

28 Luis GE, "Acromioclavicular joint dislocation: a comparative biomechanical study of the palmaris-longus tendon graft reconstruction with other augmentative methods in cadaveric models" 2 : 22-31, 2007

29 Dumontier C, "Acromioclavicular dislocations: treatment by coracoacromial ligamentoplasty" 4 : 130-134, 1995

30 이기원, "AO Hook 금속판을 이용한 견봉쇄골 관절 탈구의 치료" 대한견주관절학회 12 (12): 167-172, 2009

31 Habernek H, "A crook plate for treatment of acromioclavicular joint separation; indication, technique, and results after one year" 35 : 893-901, 1993