Analysis And Selection Of Treatment Methods For The Fresh Type Ⅲ Acromioclavicular Dislocation

Backgroundacromioclavicular dislocation is one frequent damage of the shoulder,the rate is about 12%,it often takes place to the youth and the middle age.We often divide it into three type(Tossy typeⅠ:The X-rays shows that collarbone shifts slightly,hinting acromioclavicular ligament rupture or partial breakage;Tossy typeⅡ:The X-rays shows that the half diameter of collarbone's extremity raised up and surpassed the shoulder peak,hinting acromioclavicular ligament breakage and coracoclavicular ligament tension injury.Tossy typeⅢ:The X-rays shows that collarbone's extremity displaced completely,the distance between Coracoid and collarbone increased obviously,hinting acromioclavicular ligament and coracoclavicular ligament broke completely).It becomes consensus that flesh Tossy typeⅠ,Ⅱwas treated with nonoperation,fixed with sling at first stage and functional rehabilitation at late stage,etc.As to fresh Tossy typeⅢ,it should be treated by operation at first stage to relieve symptom and improve function.Now,there are so many operative procession to solve the problem,All of them can be divided into six groups:(1)acromioclavicular joint reseted and internal fixed;(2)coracoclavicular ligament repaired,rebuilded and coracoid to collarbone fixed;(3)the distal end of collarbone resection;(4)power muscle transposition;(5)acromioclavicular joint reseted and fusion;(6)many kinds of methods united,for example,fixed with Kirschner wire combined with steel wire fixation and repaired coracoacromial ligament and aeromioclavicular ligament.,fixed with clavicle claw steel plate fixation and repaired acromioclavicular ligament.In the past time,investigation concentrated mainly on the difference of therapeutic effect, but considered less about operative harm,medical cost and operative complexity.But in the actual clinical activity,we should not only consider about the therapeutic effect, but also the surgical trauma,medical cost and operative complexity.We reviewed every method which often used in the past time,combined with the harmful and recovered method of acromioclavicular dislocation,then designed a new operative method that acromioclavicular dislocation was fixed with Intersected Kirschner wire and acromioclavicular ligament was repaired and strengthened.After using in clinic, we compared it's time,the length of operative incision,blooding,cost and the therapeutic effect with the commonly used method in the past time.So as to search for a new method,which contains merits as fellow:simply procedure,less surgical trauma,low medical cost and good effect. ObjectiveTo analyze the therapeutic effect,the length of operative incision,the amount of blood loss,the surgical time and the medical cost of 3 different methods for the treatment of the fresh typeⅢacromioclavicular dislocation,so as to select one effective,simple,less trauma and cheap method.MethodsTo retrospective analysis the time,the length of operative incision,the blooding and the cost of group A and B of the fresh typeⅢacromioclavicular dislocation which treated in our hospital during the January 2001 to the December 2004.There are 18 cases in group A,which had been treated with Kirschner wire combined with steel wire fixation to repair coracoacromial ligament and acromioclavicular ligament.There are 21 cases in group B,which had been treated with clavicle claw steel plate fixation to repair acromioclavicular ligament.The cases of the group A were followed up after pexy from 14 to 46 months(with an average of 29.6 months),And the cases of the group B were also followed up after pexy from 13 to 43 months(with an average of 26.3 months).The therapeutic effect of all the cases were evaluated by the standard of Karlsson.There are 23 cases of the fresh typeⅢacromioclavicular dislocation in group C which had been treated with intersecting Kirschner wire to repair and strengthen acromioclavicular ligament in our hospital during the October 2005 to the December 2006,also statisticsed the time,the length of operative incision,the blooding and the cost.The therapeutic effect of group C was followed up after pexy from 13 to 23 months(with an average of 18.6 months),which was also evaluated by the standard of Karlsson.The experimental data was analyzed by the software of SPSS 13.0,and an associated probability of 5%(p＜0.05) was considered significant.Results The therapeutic effect of all group is tested by rank-sum test,H=0.210,P=0.901. It shows that the difference of the shoulder joint function of all groups is not significant(P＞0.05);The time,the length of operative incision,the blooding and the cost of all group is tested by One-way ANOVA and multiple comparison.It shows that group C needs less of time,the length of operative incision and blooding than group A(P＜0.05),and group C needs less of time,the length of operative incision, cost and blooding than group B(P＜0.05).the value of all interclass is significant(P＜0.05)but the cost of A-C group(p=0.207).ConclusionIntersecting Kirschner wire to repair and strengthen acromioclavicular ligament for treatment of the fresh typeⅢacromioclavicular dislocation is an efficient,simple, less surgical trauma and low medical cost method.