Correction Of The Treatment Of Acromioclavicular Joint Dislocation And The Observation Of Fascia Metaplasia With Orthorhombic Fascia Flap

[Objective] To evaluate the clinical results and histological outcome of acute complete acromioclavicular(AC)dislocations treated with reconstructed acromioclavicular and coracoclavicular ligament by trapezius muscle fascia.[Methods] 1. 96 patients with acromioclavicular dislocation have been treated from January 2008 to December 2015. Two different surgical techniques were employed: the acromioclavicular and coracoclavicular ligaments were reconstructed by trapezius muscle fascia(in ligament reconstruction group of 47patients), open reduction and internal fixation was performed using the clavicular hook plate( in plate group of 49patients). VAS scores, Constant shoulder scores, CC.Dist were documented for analysis before and two years post-operation, SNQ of MRI and complication were documented two years post-operation. 2. Immunohistochemical study was used to observe the expression fibroblast, transforming growth factor, level of collagen type I and collagen type III.[Results] All the cases were followed up 4.8 years on average(range, 2 to 7years). The incidence of complication in ligament reconstruction group10.6%( 5/47) was significantly lower than that in plate group 67.3%(33/49)(P<0.01). VAS scores and CC.Dist significantly decreased at 2 years after operation when compared with preoperative values in the2 group(P<0.01). VAS scores and CC.Dist of the ligament reconstruction group were significantly lower those in the plate group(P<0.01). According to Constant shoulder scores at 2 years after operation, the results were(92.76±24.67) in ligament reconstruction group; the results were(79.69±21.38)in the plate group; and significant difference was shown between 2 groups(P<0.05). SNQ was significantly lower in ligament reconstruction group than in plate group at 2 years after operation(P<0.05), indicating that ligament healing was better in ligament reconstruction group than plate group. According to the immunohistochemical study,the density of fibroblast and transforming growth factor expression were higher in ligament reconstruction group than in plate group, the expression of collage type I andⅢ was positive in two groups, Type I collagen content and type I / type III collagen ratio were higher in the ligament reconstruction group, type III collagen content lower was in the plate group(P<0.05), indicating that fascia tissue metaplasia ligament structure in ligament reconstruction group.[Conclusion] Compared with simple clavicular hook plate fixation, the clavicular hook plate combined with trapezius muscle fascia for reconstruction of acromioclavicular and coracoclavicular ligament is successful in treating acute complete acromioclavicular dislocations, less complication, and early shoulder functions improving with the advantages of higher ligament healing.