The Basic And Clinical Study Of Coracoclavicular Ligament Reconstruction In The Treatment Of Acromioclavicular Dislocation

Acromioclavicular joint dislocation is the common shoulder injuries.It often causes shoulder pain and shoulder dysfunction after acromioclavicular joint injury.This study is divided into the following three parts.Part one: to guide the operation,we study the anatomical structure of acromioclavicular ligament.The second part: according to the measured anatomical data,the operation process is simulated by computer to verify the feasibility of surgery.The third part: through comparing the effect of clavicular hook plate and double Endobutton plate under arthroscopy in the treatment of acute acromioclavicular dislocation,we discuss the advantages of arthroscopic technique.Part 1 Anatomical study of acromioclavicular joint for clinical applicationObject: In this paper,40 acromioclavicular joints of 20 adult Chinese cadavers with conventional anticorrosive treatment were dissected and statistically analyzed.The accurate data of coracoclavicular ligament on clavicle and coracoid process attachment were provided,and the structural characteristics of coracoclavicular ligament were understood.To provide morphological data for anatomical reconstruction of coracoclavicular ligament.Methods: The conoid and trapezoid ligaments were dissected and marked on the attachment of clavicle and coracoid process to determine the center of attachment point,to measure the distance between the footprint centers and the edges of clavicle and coracoid process.The relative position of ligaments on clavicle and coracoid process was calculated,and all the measured data were analyzed statistically by SPSS20.0 software.Result: The average length of clavicle was 151.6±13.5 mm,the average distance between the conoid ligament and lateral edge of clavicle was 38.1 ± 3.4 mm,the average distance to anterior edge was 12.6 ± 1.1 mm,the average distance to posterior edge was 6.5±1.3 mm,the average distance between trapezoid ligament and distal clavicle was 23.7±2.1 mm,and the average distance to anterior edge was 9.5 ±1.1 mm,The average distance to the posterior edge to the distal clavicle was 10.5 ±1.1 mm,the average ratios of the distance from the lateral edge of the clavicle to the center of the conoid divided by the clavicular length was 25.2%,The ratios of the distance from the posterior edge of the clavicle to the center of the conoid divided by the clavicular Width was 33.6%,the average ratios of trapezoid ligament from the lateral edge was 15.7%,the average ratios of trapezoid ligament from the posterior edge was 52.6%.The average length of coracoid process was 43.2 ±3.1 mm,the average distance between conoid ligament and coracoid tip was 38.3 ±1.8 mm,the average distance to lateral cortex was 10.1 ±0.8 mm,the average distance to medial cortex was 1.9 ±0.3 mm,The average distance between trapezoid ligament and coracoid tip was 30.3 ±2.2 mm,and the average distance to lateral cortex was4.6 ±0.7 mm,and the average distance to medial cortex was 9..0 ±0.9mm,the average ratio of conical ligament from coracoid tip was 88.8%,the average ratio from medial cortex was16.1%,The average ratio of trapezoid ligament from coracoid tip was 70.1%,the average ratio from medial cortex was 66.4%.Conclusion: Through our anatomical measurements and analysis,we find that:1.The ratios of the conoid ligament and the trapezoid ligament from the distal clavicle are relatively constant.So measuring the length of the clavicle before coracoclavicular ligament reconstruction is helpful for accurate anatomical reconstruction.2.Reconstructing the coracoid ligament followed by the footprints of the conoid ligament and the trapezoid ligament may cause coracoid process fracture.Part 2 Computer simulation analysis of coracoclavicular ligament reconstructionObject : To prove the feasibility of anatomical reconstruction of coracoclavicular ligament.Methods : From January 2015 to January 2017 in our hospital,a total of 40three-dimensional acromioclavicular joint models were constructed using software,based on computed tomography(CT)scan data.The operation process was simulated by computer and the risk of operation was analyzed.Result:In anatomic reconstruction,there were 2 cases of success and 38 cases of failure,and the success rate was 5%.The medial coracoid cortex was destroyed in all failed cases.In single bundle reconstruction,40 cases were successful,0 cases failed,and the success rate was 100%.In approximate anatomic reconstruction,40 cases were successful,0 cases failed,and the success rate was 100%.The success rate of single bundle reconstruction and approximate anatomic reconstruction was significantly higher than that of anatomical reconstruction.Conclusion:1.The perfect anatomical reconstruction of the coracoid ligament is difficult to achieve by current collinear drilling technique.2.We put forward the concept of approximate anatomic reconstruction of coracoclavicular ligament,which can effectively reduce the risk of iatrogenic coracoid process fracture.3.The single bundle reconstruction of coracoclavicular ligament,which is commonly used in clinic at present,is a reliable surgical method.Part 3 Comparison of clavicular hook plate and double Endobutton plate in the treatment of acute acromioclavicular dislocationObject:To compare the effect of clavicular hook plate and double Endobutton plate under arthroscopy in the treatment of acute acromioclavicular dislocation.Methods:From January 2015 to January 2017,the data of 40 patients with acute acromioclavicular dislocation were collected and divided into two groups according todifferent operative methods: clavicular plate group and double Endobutton plate group.In this study,we compared the Visual Analog Scale(VAS)Score、the American Shoulder and Elbow Surgeon(ASES)Score 、 the range of motion of shoulder joint and postoperative complications.Result:The average follow-up time was 24 months(12 ~ 36 months).The ASES score of clavicular hook plate group improved from 27.6 ±7.1 to 86.6 ±7.2,and the ASES score of double Endobutton plate improved from 27.4 ±7.4 to 95.6 ±7.2.There was no significant difference in VAS score between the two groups.The ASES score of double Endobutton plate group was better than that of clavicular hook plate group in each period,and the range of motion of shoulder joint was better than that of clavicular hook plate group at 1 year after operation.Conclusion:We believe that the treatment of acute acromioclavicular joint dislocation with double Endobutton plate has the advantages of less surgical trauma,better postoperative recovery,less complications,and no need to remove the fixation.