Treatment of Tossy III acromioclavicular joint dislocation: biomechanical change of anchor-reconstructed coracoclavicular ligament

doi:10.3969/j.issn.2095-4344.2015.04.013

Abstract

Abstract:

BACKGROUND: The commonly used methods of repairing the acromioclavicular joint dislocation are Kirschner wire tension band internal fixation, clavicular hook internal fixation and suture anchor internal fixation. Each method has their advantages and disadvantages. Both Kirschner wire and clavicular hook require secondary surgery to remove the internal fixators, and their design is not based on the biomechanical principle.

OBJECTIVE: To reconstruct coracoclavicular ligament using anchor and perform biomechanical tests.

METHODS: Ten shoulder antisepsis specimens were numbered and each specimen was tested by three trials. (1) Stretching coracoclavicular ligament: Specimens were fixed on the biomechanical machine and were tensile until the ligament was ruptured, the maximum failure load was recorded. (2) Reconstruction of coracoclavicular ligament using an anchor: Coracoclavicular ligment was reconstructed using an anchor, then specimens were fixed on the biomechanical machine and were tensile until the ligament was ruptured, the maximum failure load was recorded. (3) Reconstruction of coracoclavicular ligament using two anchors: Coracoclavicular ligment was reconstructed using two anchors, then specimens were fixed on the biomechanical machine and were tensile until the ligament was ruptured, the maximum failure load was recorded.

RESULTS AND CONCLUSION: Coracoclavicular ligament fracture load was (413.0±123.48) N; the failure load was (345.1±111.23) N in an anchor group and 465.3±100.64 N in two anchors group. When coracoclavicular ligament is reconstructed using an anchor, the stress is concentrated under external forces, which is prone to the extraction of anchor and the failure of surgery, biomechanical data showed that the fracture load is lower than the coracoclavicular ligament, so the reconstruction is not reliable; when coracoclavicular ligament is reconstructed using two anchors, the stress is dispersed, which meet the biological features and the biomechanical data are ideal.

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: Internal Fixators, Coracoclavicular Ligment, Dislocations, Ligaments, Biomechanics

CLC Number:

R318

Han Bing, Feng Hui, Chen Shuo, Wang De-guang, Zhang Chuan-kai. Treatment of Tossy III acromioclavicular joint dislocation: biomechanical change of anchor-reconstructed coracoclavicular ligament[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(4): 568-572.

Figures/Tables 2

References

[1] Johansen JA , Grutter PW, McFarland EG, et al. Acromioclavicular joint injuries: indications for treatment and treatment options. J Shoulder Elbow Surg. 2011; 20(2Suppl): S70-82.
[2] Babhulkar A, Pawaskar A. Acromioclavicular joint dislocations. Curr Rev Musculoskelet Med. 2014;7(1):33-39.
[3] Takase K, Yamamoto K. Changes in surgical procedures for acromioclavicular joint dislocation over the past 30 years. Orthopedics. 2013;36(10):e1277-1282.
[4] Lizaur A , Sanz-Reig J, Gonzalez-Parreño S. Long-term results of the surgical treatment of type III acromioclavicular dislocations: an update of a previous report. J Bone Joint Surg Br. 2011; 93(8):1088-1092.
[5] 曹前来,张磊,韦飞,等. AO/ASIF锁骨钩钢板治疗肩锁关节全脱位及锁骨远端不稳定骨折中的应用[J].中国矫形外科杂志,2004,12(23): 829-1831.
[6] 赵友明.洪汝康.王振文.重度肩锁关节脱位的手术治疗[J].中国骨伤,2001,14(4):202-203.
[7] Nissen CW, Chatterjee A. Type III acromioclavicular separation: results of a recent survey on its management. Am J Orthop (Belle Mead NJ). 2007;36(2):89-93.
[8] 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.
[9] Dou Q , Ren X .Clinical therapeutic effects of AO/ASIF clavicle hook plate on distal clavicle fractures and acromioclavicular joint dislocations. Pak J Med Sci. 2014; 30(4):868-871.
[10] Guan TJ , Sun P , Zheng LG , et al .Case-control study on measurement of coracoclavicular and acromioclavicular ligament injuries during internal fixation operation for the treatment of fresh acromioclavicular joint dislocation of Tossy type III. China J Orthop Traumatol. 2014;27(1):13-16.
[11] Jafary D, Keihan Shokouh H. Clinical and radiological results of fixation of acromioclavicular joint dislocation by hook plates retained for more than five months. Trauma Mon. 2014;19 (2): e13728.
[12] Lin HY, Wong PK, Ho WP, et al. Clavicular hook plate may induce subacromial shoulder impingement and rotator cuff lesion--dynamic sonographic evaluation. J Orthop Res. 2014; 9:6.
[13] Zhang JW , Li M, He XF, et al. Operative treatment of acromioclavicular joint dislocation: a new technique with suture anchors. Zhonghua Chuangshang Zazhi. 2014; 17(4): 187-192.
[14] Xu ZB , Wang J .Clavicular hook plate combined with suture anchor for the treatment of type Tossy III chronic acromioclavicular dislocation. Zhongguo Gu Shang. 2014; 27(5): 430-432.
[15] Grutter PW, Petersen SA. Anatomical acromioclavicular ligament reconstruction: a biomechanical comparison of reconstructive techniques of the acromioclavicular joint. Am J Sports Med. 2005;33(11):1723-1728.
[16] Salzmann GM, Paul J, Sandmann GH, et al. The coracoidal insertion of the coracoclavicular ligaments: an anatomic study. Am J Sports Med. 2008;36(12):2392-7239.
[17] Beitzel K, Obopilwe E, Apostolakos J, et al. Rotational and translational stability of different methods for direct acromioclavicular ligament repair in anatomic acromioclavicular joint reconstruction . Am J Sports Med. 2014 Sep;42(9): 2141-2148.
[18] Wellmann M, da Silva G , Lichtenberg S , et al. Instability pattern of acromioclavicular joint dislocations type Rockwood III : Relevance of horizontal instability. Der Orthopade 2013.
[19] 陈启明,梁国穗,译.骨关节肌肉系统生物学和生物力学[M]. 2版.北京:人民卫生出版社,2001:519.
[20] Shin SJ, Campbell S, Scott J, et al. Simultaneous anatomic reconstruction of the acromioclavicular and coracoclavicular ligaments using a single tendon graft.Knee Surg Sports Traumatol Arthrosc. 2014;22(9):2216-2222.
[21] 胥少汀,葛宝丰,徐印坎.实用骨科学[M]. 4版.北京:人民军医出版社,2012:526.
[22] 张继东,孙献勇. 锁骨钩钢板与克氏针张力带固定治疗锁骨远端骨折与肩锁关节脱位[J].中国骨与关节损伤杂志,2009,24(2): 36-37.
[23] 毛伟欢,金永明,孙成长,等.应用钩钢板治疗肩锁关节脱位[J].实用骨科杂志,2005,11(5):442-443.
[24] 王磊,宋恒平,申自权,等.锁骨钩钢板治疗肩锁关节脱位的临床体会[J]. 解剖与临床,2006,11(3):195-196.
[25] 陈云苏,陈峥嵘,姚振均,等.锁骨钩钢板治疗肩锁关节脱位和锁骨远端骨折[J].中华创伤志,2003,19(5):300-302.
[26] 肖谦,向芳友,陈尉.锁骨钩钢板治疗肩锁关节脱位术后肩关节疼痛原因分析[J].中国现代医学杂志, 2007,17(5):143-144.
[27] 张庆天.锁骨钩钢板治疗肩锁关节脱位疼痛原因分析[J].中医正骨, 2012,24(11):50-51.
[28] 曹振孝,张在谦,常浩胜,等.带线锚钉内固定治疗TossyⅢ型肩锁关节脱位[J].实用骨科杂志,2013,19(10):59-61.
[29] 张经纬,李明,何贤峰,等.带线锚钉与锁骨钩钢板治疗肩锁关节脱位疗效比较[J].中国骨与关节损伤杂志,2014,29(7):57-59.
[30] 马仲锋,齐明,王心宽.肩锁钩钢板联合带线锚钉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,2014,29(9):88-89.