肩鎖関節脱臼に対するＷｅａｖｅｒ変法の検討

Abstract

It is not easy to maintain anatomical restoration conservatively for acromioclavicular separation. We have reported previously that reconstruction of acromioclavicular or coracoclavicular ligament offers superior result to the simple transfixation of acromioclavicular joint by the Kirschner wires.Nine patients treated by modified Weaver procedure were reviewed and were compared to the five patients by modified Dewar procedure and a patient by modified Neviaser procedure. At review, a functional result of the shoulder including pain, range of motion, muscle weakness and activity of daily living was evaluated . A radiographic result was also evaluated. The displacement less than 50% of the width of clavicle was rated as good restoration.Seven patients were satisfactory in the functional assessment, but the good restoration was maintained only in four patients. The fact that the poor restoration doesn't always lead to poor function, encourages conservative treatments.The fifteen patients who had been treated operatively, were assigned into good restoration group (8) and poor restoration group (7). Functional assesment was significantly (p<0.05) higher in good restoration group. We concluded the operative procedure which can maintain good restoration to be the better treatment. On that standpoint of view, the transfer of coracoacromial ligament as a substitute for coracoclavicular ligament seems to be insufficient for the acromioclavicular separation.