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Clavicular hook plate + coracoclavicular ligament reconstruction for acromioclavicular joint dislocation_2166

By Anna Ferguson,2014-10-30 14:15
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Clavicular hook plate + coracoclavicular ligament reconstruction for acromioclavicular joint dislocation_2166

Clavicular hook plate + coracoclavicular ligament

    reconstruction for acromioclavicular joint dislocation

     Papers Key words acromioclavicular joint dislocation; internal fixation; coracoclavicular ligament reconstruction

     Abstract Objective To evaluate the clavicular hook plate fixation of

    coracoclavicular ligament reconstruction for treatment of acromioclavicular joint dislocation of the clinical effects. Methods from January 2001 to December 2007 during the acromioclavicular joint dislocation inpatients, which uses screw coracoclavicular coracoclavicular ligament reconstruction surgery and received follow-up of 27 cases,

    and follow-up assessment of efficacy. The results based on the standard assessment of efficacy Karlsson, using the surgical method and get follow-up of 27 patients, 25

    patients with daily activities, work and exercise properly, ipsilateral shoulder without discomfort symptoms; two cases of mild pain during physical and sports. X-ray film

    found in 27 cases of each contributed acromioclavicular joint anatomic reduction. Conclusion clavicular hook plate coracoclavicular ligament reconstruction is the treatment of acromioclavicular joint dislocation of a reliable method that is simple, effective precise and effective provision of early and late mechanical stability of the biological, worthy to be popularized.

     Clavicular hook plate has been widely used in severe treatment of acromioclavicular joint dislocation, with effect accurate, method is simple, early postoperative restore

    joint function, etc., but often surgical operation is shorter because of coracoclavicular ligament, ligament repair difficulties, So simple I clavicular hook plate fixation or repair the ligaments become a mere formality, so clavicular hook plate removed again

    after the acromioclavicular joint dislocation. in our hospital from January 2001 to December 2007 during the acromioclavicular joint dislocation inpatients, of which Some use screw coracoclavicular coracoclavicular ligament reconstruction surgery and

    achieved satisfactory results, the final report are the following.

     A clinical data

     1.1 General information on this group classification of acute acromioclavicular dislocation were ?, a total of 27 cases, male 18 cases and 9 females, aged 21 to 53 years, mean 35 years. 17 cases left, right, 10 cases were unilateral. 22 cases of car accidents, falls, 5 cases were visiting time after injury within 24 h. Three cases in which a trial after the failure of manual reduction and external fixation surgery and other cases are referred directly to surgery.

     1.2 Surgical Methods brachial plexus block or general anesthesia, supine position, head tend to the healthy side, suffering from shoulder Xiadian a thin line of shoulders

    square pillow upper anterolateral incision, revealing and detecting acromioclavicular joint, removing a small bone fragments blocks, free of the ligaments and intra-articular

    hematoma, such as the destruction of articular cartilage disc in serious it could be

    removed. Blunt separation of the deltoid muscle bend pliers, revealed coracoid process, using autogenous fascia lata to bypass the beak of the conflict, from the deltoid muscle to wear to and around the tunnel in the clavicle, the outer 1 / 3 at the junction, the

    repair of acromioclavicular joint, the clavicle The hook end hook plate was inserted into the bottom after the acromion, the use of leverage will be steel, as well as the subclavian pressure, to ensure full reset, the conventional installation of steel plate

    fixed on the clavicle, repair ligament Acromioclavicular joint capsule sutured to tighten the fascia lata of and fixed on the clavicle. Surgery operation to protect the subclavian vessels and nerves, collarbone periosteum to avoid over-stripping.

     1.3 Postoperative management after the appropriate use of antibiotics to prevent wound infection, bandage hanging limb about 1 week, during which the discretion given to pain treatment, that is a passive activity to alleviate the pain of shoulder, 1

    week after the initiative, he gradually resumed daily activities. After internal fixation was removed 6 to 8 months.

     2 Results

     The patients were followed up 1 to 5 years, 27 patients have been dismantled within

    the implant, shoulder shape and normal, no obvious deformity, floating sensation disappeared, 25 cases of daily activities, work and exercise normal ipsilateral shoulder without discomfort; 2 cases of mild pain during physical and sports, X-27 cases

    reviewed there was no recurrence of acromioclavicular joint dislocation. According to Karlsson [1] after efficacy score standards, excellent: pain, upper limb muscle strength to normal, shoulder so easily, X-ray film showed acromioclavicular joint space ? 5 mm;

    Liang:

     Micro-pain, limited shoulder mild activity, X-ray film showed acromioclavicular

joint space 5 ~ 10 mm; worse: pain, severe shoulder activity

     Restricted, X-ray showed dislocation of the acromioclavicular joint is still the standard assessment of shoulder function of the standard, this group of cases excellent in 25 cases, good in 2 cases.

     3 Discussion

     Acromioclavicular joint main function is to provide the sliding between the clavicle and the acromion and scapula rotation relative to the clavicle. The stability of the acromioclavicular ligaments rely to maintain, up and down on the direction of the stability of the coracoclavicular ligaments, the horizontal direction on the stability of the acromioclavicular ligament, joint capsule and deltoid, trapezius tendon fibers. Clavicular joint dislocation of the shoulder are very common sports injuries common in young people. Acromioclavicular joint dislocation mechanisms of direct violence and indirect violence caused by two types of direct violence is more common, acromion on the hit, so that subsidence of acromion and the scapula, resulting in the structure of acromioclavicular ligament rupture, if the violence is too large , there will be attached to the clavicle on the trapezius and deltoid muscle fibers break point only, and extension of Acromioclavicular ligaments and meniscus. If the violence is too large will also coracoclavicular coracoclavicular ligament rupture. Another form of indirect violence, the dumping of a fall in the shoulder and elbow are at 90 ? flexion position, this time to live glenoid humeral head and acromion, to the rear transmission of violence can make acromioclavicular ligament and coracoclavicular ligament rupture. Reposted elsewhere in the paper for free download http://

     At present, the treatment of acromioclavicular joint dislocation method is more chaotic, orthopedic surgeons on the surgical methods did not reach consensus on a common approach, such as open reduction with tension band fixation, simple I

    clavicular hook plate fixation of clavicle - coracoid Rally screw fixation. However, there

    is often inside the implant fracture, screw extrusion, internal fixation, after removal of the recurrence of dislocation, etc., therefore, in the clavicular hook plate, while the

    dislocation of the restoration, reconstruction of the coracoclavicular ligament treatment of acromioclavicular joint dislocation has an important significance. Clavicular hook plate in acromioclavicular joint in accordance with anatomical

    characteristics of the design, use of their own strength and leverage to effectively combat sternocleidomastoid traction forces, the impact on the rotator cuff is small, do not interfere with acromioclavicular acromioclavicular joint and allow the micro to

    avoid post-operative occurrence of traumatic arthritis, and the simple, reliable fixation, allows early functional exercise, so that its function was to maximize recovery. The coracoclavicular ligament reconstruction, the effective delivery of long-term biological

    stability. Coracoclavicular ligament reconstruction of many ways, including the artificial tendon or fascia lata transplantation, artificial tendon or fascia coracoclavicular ligament repair on local trauma, simple operation and less damage of

    normal tissues. The artificial tendon histocompatibility good, high tensile strength, has been widely used in clinical, but the more expensive and not easily accepted by the

author in patients with grass-roots level. Despite an increase in body fascia lata from

    the patient's pain, but since the tissue, as well as economic reasons, more susceptible to grass-roots level I patients. The author of article on the use of fascia lata in patients with follow-up of more than 1 year are no significant relaxation of acromioclavicular

    joint dislocation or phenomenon, consider the reason is the acromioclavicular joint activity itself is small, in the acromioclavicular joint capsule and ligaments are fully restored , coracoclavicular ligaments will be significantly reduced. Therefore, I believe that clavicular hook plate fixation fascia coracoclavicular ligament reconstruction of acromioclavicular joint dislocation used in this operation is consistent with the treatment of acromioclavicular joint request, the effective delivery of early mechanical stability and long-term biological stability, to maximize the restoration of the structural integrity of the acromioclavicular joint and its function, and operation is simple, cost is relatively low, it is worthwhile to primary hospital clinic.

     References

     [1] Lei-ming. Coracoclavicular ligament reconstruction for acromioclavicular joint dislocation. Zhonghua Surgery, 1987,25 (2): 70.

     [2] Huang-Chun. Clavicle hook acromioclavicular joint dislocation in 11 cases.

    Liaoning Journal of Traditional Chinese Medicine ,2004,6:476-477.

     [3] Karlsson J, Arnarson H, Sigurionsson K. Acromioclavicular dislocations treated by coracoacromial ligament transfer.Arch Orthop Truma Surg ,1986,106:8-11.

    Reposted elsewhere in the paper for free download http://

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