Clavicular hook plates for acute acromioclavicular dislocations: simultaneous repair of coracoclavicular ligament?

doi:10.3969/j.issn.2095-4344.2014.17.012

Abstract

Abstract:

BACKGROUND: Clavicular hook plates have been used widely to treat acromioclavicular dislocations in recent years. However, it remains controversial whether coracoclavicular ligament should be repaired during the surgery.
OBJECTIVE: To study the clinical effect and MRI manifestations after treatment of type III and V acute acromioclavicular Rockwood dislocation with clavicular hook plate, and to discuss the necessity of repairing coracoclavicular ligament during the surgery.
METHODS: A total of 44 patients with type III and V acute acromioclavicular Rockwood dislocations were treated with clavicular hook plates without repair of coracoclavicular ligaments, and underwent plate removal operations later. At 24 months after the second surgery, X-rays were taken to measure the width of coracoclavicular joints in both normal and affected limbs, Constant-Murley scores were calculated in both sides, and MR images were used to observe the healing of coracoclavicular ligaments.
RESULTS AND CONCLUSION: 39 patients (89%) were followed up for 36.9±3.1 months (range, 30 to 45 months). The mean duration for retaining clavicular hook plates was 12.9±3.1 months (range, 6 to 21 months). The mean width of coracoclavicular joints was 6.04±1.21 mm (range, 4.3 to 8.8 mm) in normal limb, while 5.09±1.18 mm (range, 3.4 to 7.8 mm) in affected side without significant difference (P > 0.05). The mean Constant-Murley score was 98.9±1.2 (range, 96 to 100) in normal limb, while 96.7±3.4 (range, 90 to 100) in affected side without significant difference (P > 0.05). MRI showed healing of the coracoclavicular ligaments and the presence of continuous scar tissue in 38 patients, excluding one patient with recurrence of acromioclavicular joint dislocation. The clinical effects after treatment of type III and V acute acromioclavicular Rockwood dislocation with clavicular hook plate are satisfactory, and it is unnecessary to repair coracoclavicular ligament during the surgery. MR images reveal scar healing of the coracoclavicular ligaments without operative repair.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: clavicle, acromioclavicular joint, dislocations, internal fixators, ligaments

CLC Number:

R318

Gui Ke-ke, Zhang Xin-chao, Yin Wang-ping, Yu Yong-lin . Clavicular hook plates for acute acromioclavicular dislocations: simultaneous repair of coracoclavicular ligament?[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(17): 2691-2696.

Figures/Tables 1

2.1 参与者数量分析纳入患者44例，5例患者在取出内固定后中途退出，39例(89%)获得随访，进入结果分析。 2.2 随访情况与疗效评价随访时间为(36.9±3.1)个月(30-45个月)，锁骨钩钢板在体内存留时间为(12.9±3.1)个月(6-21个月)。在锁骨钩钢板取出术后24个月，通过肩关节正位X射线片测量双侧喙锁间隙，健侧平均为(6.04± 1.21) mm (4.3-8.8 mm)，患侧平均为(5.09±1.18) mm (3.4-7.8 mm)，差异无显著性意义(P > 0.05)。对双侧肩关节功能进行Constant评分，健侧平均为(98.9±1.2)分(96-100分)，患侧平均为(96.7±3.4)分(90-100分)，差异无显著性意义(P > 0.05)。通过对不同方向的MRI扫描结果进行比较后发现，平行于喙突与肱骨小结节连线的斜冠状位能清晰的显示肩锁关节和喙锁韧带的走向。除了1例发生肩锁关节再脱位的患者外，其余38例患者的MRI扫描均显示喙锁韧带处有连续的瘢痕组织形成，提示喙锁韧带已愈合。 2.3 典型病例分析病例1：男性患者，61岁，车祸伤致左侧肩锁关节脱位(Rockwood Ⅲ型)(图1A)；伤后3 d手术，采用锁骨钩钢板内固定，复位满意(图1B)；内固定钢板取出后24个月，未发生再脱位(图1C)，喙锁韧带已愈合(图1D，E)。病例2：男性患者，30岁，坠落撞击伤致右侧肩锁关节脱位(Rockwood Ⅴ型)(图2A)；伤后当日手术，采用锁骨钩钢板内固定，复位满意(图2B)；内固定钢板取出后24个月，未发生再脱位(图2C)，喙锁韧带已愈合(图2D，E)。 2.4 不良反应评价所有病例均无切口感染、钢板周围骨折、钢板螺钉断裂发生。1例患者在取出钢板前发生螺钉松动。2例患者在内固定后出现肩部疼痛的症状，给予口服药物、理疗等保守治疗，待取出钢板后症状有所缓解。4例患者取出钢板后X射线平片出现骨关节炎表现。1例患者在取出钢板后发生肩锁关节再脱位，但程度较原先脱位减轻，未行进一步治疗。"

References

[1] Warth RJ, Martetschläger F, Gaskill TR, et al. Acromioclavicular joint separations. Curr Rev Musculoskelet Med. 2013;6(1):71-78.
[2] Ha AS, Petscavage-Thomas JM, Tagoylo GH. Acromioclavicular joint: the other joint in the shoulder. AJR Am J Roentgenol. 2014;202(2):375-385.
[3] Kim AC, Matcuk G, Patel D, et al. Acromioclavicular joint injuries and reconstructions: a review of expected imaging findings and potential complications. Emerg Radiol. 2012; 19(5):399-413.
[4] Beitzel K, Cote MP, Apostolakos J, et al. Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy. 2013;29(2):387-397.
[5] Willimon SC, Gaskill TR, Millett PJ. Acromioclavicular joint injuries: anatomy, diagnosis, and treatment. Phys Sportsmed. 2011;39(1):116-122.
[6] Eschler A, Gradl G, Gierer P, et al. Hook plate fixation for acromioclavicular joint separations restores coracoclavicular distance more accurately than PDS augmentation, however presents with a high rate of acromial osteolysis. Arch Orthop Trauma Surg. 2012;132(1):33-39.
[7] Smith TO, Chester R, Pearse EO, et al. Operative versus non-operative management following Rockwood grade III acromioclavicular separation: a meta-analysis of the current evidence base. J Orthop Traumatol. 2011;12(1):19-27.
[8] Trainer G, Arciero RA, Mazzocca AD. Practical management of grade III acromioclavicular separations. Clin J Sport Med. 2008;18(2):162-166.
[9] Gstettner C, Taubor M, Hitzl W, et al. Rockwood type III acromioclavicular dislocation: surgical versus conservative treatment. J Shoulder Elbow Surg. 2008;17(2):220-225.
[10] 刘松,秦士吉,张英泽.肩锁关节脱位的手术治疗进展[J]. 中华创伤骨科杂志,2013,15(4):349-351.
[11] 蔡宇,王凯,梁晶峰.肩锁关节脱位重建:金属植入物的选择[J]. 中国组织工程研究与临床康复,2011,15(4):721-724.
[12] Faraj AA, Ketzer B. The use of a hook-plate in the management of acromioclavicular injuries. Report of ten cases. Acta Orthop Belg. 2001;67(5):448-451.
[13] De Baets T, Truijen J, Driesen R, et al. The treatment of acromioclavicular joint dislocation Tossy grade III with a clavicle hook plate. Acta Orthop Belg. 2004;70(6):515-519.
[14] Nadarajah R, Mahaluxmivala J, Amin A, et al. Clavicular hook-plate: complications of retaining the implant. Injury. 2005;36(5):681-683.
[15] Di Francesco A, Zoccali C, Colafarina O, et al. The use of hook plate in type III and V acromio-clavicular Rockwood dislocations: clinical and radiological midterm results and MRI evaluation in 42 patients. Injury. 2012;43(2):147-152.
[16] 仲飙,陈华,孙辉,等.锁骨钩钢板治疗TossyⅢ型肩锁关节脱位的疗效[J].中华创伤骨科杂志,2008,10(1):41-43.
[17] 吴添龙,涂以济,陈伟才,等.锁骨钩钢板治疗急性肩锁关节脱位喙锁韧带重建与否的疗效比较[J].中国矫形外科杂志,2013,21(16): 1597-1600.
[18] Schaefer FK, Schaefer PJ, Brossmann J, et al. Experimental and clinical evaluation of acromioclavicular joint structures with new scan orientations in MRI. Eur Radiol. 2006;16(7): 1488-1493.
[19] Alyas F, Curtis M, Speed C, et al. MR imaging appearances of acromioclavicular joint dislocation. Radiographics. 2008;28(2): 463-479.
[20] 张伟伟,王诗波,冯彦华,等.肩锁固定和喙锁固定治疗肩锁关节脱位的疗效比较[J].中国矫形外科杂志,2012,20(20):1829-1832.
[21] 张伟伟,王诗波,冯彦华,等.肩锁与喙锁关节植入物内固定治疗肩锁关节脱位疗效比较的Meta分析[J].中国组织工程研究,2012, 16(48):8997-9001.
[22] Moinfar AR, Murthi AM. Anatomy of the pectoralis minor tendon and its use in acromioclavicular joint reconstruction. J Shoulder Elbow Surg. 2007; 16(3): 339-346.
[23] Walz L, Salzmann GM, Fabbro T, et al. The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: a biomechanical study. Am J Sports Med. 2008;36(12):2398-2406.
[24] Struhl S. Double endobutton technique for repair of complete acromioclavicular joint dislocations. Techn Shoulder Elbow Surg. 2007;8(4):175-179.
[25] 林朝晖,林凤飞,郑明,等.线缆重建喙锁韧带治疗肩锁关节脱位[J]. 中国骨与关节损伤杂志,2011,26(9):827-828.
[26] 刘伯龄,张森,吴建军,等.钛缆结合钛网板与锁骨钩钢板治疗完全性肩锁关节脱位临床疗效观察[J].中国矫形外科杂志,2011, 19(16):1329-1331.
[27] 毛小成,赵枫,曹杰,等. LARS人工韧带重建喙锁韧带治疗肩锁关节脱位[J].中国骨与关节损伤杂志,2011,26(1):64-65.
[28] 陈云丰,陆叶,王海明,等. ENDOBUTT0N技术重建喙锁韧带治疗肩锁关节脱位[J].中华创伤骨科杂志,2011,13(6):539-543.
[29] 许福生,李桓毅,史源欣,等.双Endobutton技术与锁骨钩钢板治疗TossyⅢ型肩锁关节脱位的疗效比较[J].中华创伤骨科杂志, 2013,15(4):283-287.
[30] 汪李军,杨惠林,刘方刚,等.三重带袢纽扣钢板与锁骨钩钢板治疗急性肩锁关节脱位的疗效比较[J].中国矫形外科杂志,2012, 20(8):700-703.
[31] 王海明,陈云丰,陆叶,等. Triple-Endobutton技术与锁骨钩钢板置入治疗肩锁关节脱位的比较[J].中国组织工程研究,2012, 16(17):3105-3110.