修復不能な広範囲腱板断裂に対する Paavolainen 法の中期治療成績

抄録

Treatment of irreparable rotator cuff tears remains controversial. Infraspinatus / teres minor transfer to the greater tuberosity has been proposed for the treatment of irreparable tears associated with severe functional impairment and chronic, disabling pain by Paavolainen et al. in 1990. After that, however, there were few reports of mid- or long-term follow-up studies. Our purpose of this study was to investigate and analyze the results of the Paavolainen's procedure over 3 years. From 1986 to 2003, 18 patients with 18 irreparable, massive tears were managed with an Infraspinatus / teres minor transfer and were evaluated clinically and radiographically after an average of 5.7 years. The study group included 9 men and 9 women, with an average age of 66.9 years old at the time of the surgery. The outcome assessment included the JOA and DASH scores and the range of motion of active flexion and external rotation. Osteoarthritis and upper migration of the humeral head were evaluated on standardized radiographs. The mean JOA score improved from 45.7 preoperatively to 74.6 at the time of the follow-up. The mean postoperative DASH score was 27.9. Flexion increased from 82.5° to 123.4°. There was no significant improvement in external rotation. 15 had significant progress of the osteoarthritic change and 13 had progress of the upper migration of the humeral head. 12 patients were satisfied with their shoulder condition. 3 shoulders had rupture of the transferred tendon and another had humeral head replacement with a latissimus dorsi transfer. Though the disabling pain improved in most patients, the osteoarthritic change progressed in 83.3% and further long-term follow-up was necessary.