反復性肩関節脱臼・亜脱臼に対する治療法の比較： Modified Inferior Capsular Shift 法 vs. 鏡視下バンカート修復術

抄録

The purpose of this study was to compare patients with recurrent anterior dislocation and subluxation of the shoulder who were treated with a modified inferior capsular shift method with those treated with an arthroscopic Bankart suture repair. 51 shoulders were surgically treated. The patients were divided into 2 groups. In group M (21 shoulders), modified inferior capsular shift method was performed, and in group B (30 shoulders), arthroscopic Bankart suture repair was performed. The groups were homogeneous in gender, dominance, age, age at 1st dislocation (subluxation), number of dislocations or subluxations, time elapsed between 1st dislocation (subluxation) and surgery. The average follow-up for group M was 15.1 months, and for group B, it was 17.7 months. The postoperative rehabilitation was the same in both groups. Follow-up evaluations included JOA, Constant, JSS-SSI, Rowe shoulder scores and limitation of range of shoulder motion. Statistical analysis of data was performed using Welch's t test (significance for P <0.05). In group M, one of the 21 patients had experienced apprehension in the follow-up period, but no patients had a dislocation. In group B, 2 (6.7%) of the 30 shoulders experienced a dislocation. The follow-up JOA, Constant, JSS and Rowe shoulder scores of the 2 groups were not significantly different. The only significant difference seen between the 2 groups was for range of motion evaluation with the Constant score and JSS-SSI score. The mean value for group M was significantly greater than that for group B (Constant; p=0.036, JSS; p=0.028,). Though the follow-up reported was short, arthroscopic Bankart suture repair was an effective surgical technique as well as the modified capsular shift method. In our study, Bankart suture repair was superior for an internal rotation and flexion than a modified inferior capsular shift method.