鎖骨関節再建術後に再発した肩峰鎖骨関節脱臼と関連する角膜骨折

Recurrent acromioclavicular joint dislocation with an associated coracoid fracture following acromioclavicular joint reconstruction.

• M Karia
• N Al-Hadithy
• G Tytherleigh-Strong

抄録

鎖骨関節損傷は一般的であり、肩甲帯損傷全体の12％を占め、スポーツ関連の肩の損傷では50％にも上ると報告されています。鎖骨関節脱臼の大部分は非手術で治療できますが、オーバーヘッドアスリートの高悪性度脱臼を含む特定の傷害構成があり、手術が必要となる場合があります。鎖骨関節の不安定性の外科的管理は、鎖骨を角膜上に再懸濁させることで、鎖骨靭帯の作用を再現する方向に向かっています。高強度の縫合糸、合成靭帯、腱移植や自家移植などを用いた複数の手技が記述されています。しかし、これらの手技に関連した異常な、しかし重要な合併症は、角膜突起の異所性骨折である。我々は、人工靭帯を用いた肩鎖鎖関節の再灌流再建術に2回失敗した後に輪状突起骨折を起こした患者の症例を報告する。この損傷は、最初はフックプレートで保護された自家製ハムストリングス移植片の再建で治療が成功した。

Acromioclavicular joint injuries are common and account for up to 12% of all shoulder girdle injuries and have been reported as being as high as 50% in sports-related shoulder injuries. While the majority of acromioclavicular joint dislocations can be treated non-operatively, there are certain injury configurations, which can include high-grade dislocations in overhead athletes, where surgery may be indicated. The surgical management of acromioclavicular joint instability has moved towards recreating the action of the coracoclavicular ligaments by resuspending the clavicle on to the coracoid. Multiple techniques using high-strength sutures, synthetic ligaments, tendon allografts or autografts passed either around or through the coracoid process have been described. However, an unusual, but significant, complication associated with these techniques is an iatrogenic fracture of the coracoid process. We report the case of a patient with an iatrogenic coracoid fracture following two failed acromioclavicular joint resuspensory reconstructions using a synthetic ligament. This injury was successfully treated with an autologous hamstring graft reconstruction, initially protected with a hook plate.