Sprengel 変形に対する肩甲骨骨切り術後の下方回旋について

抄録

Although functional results of Wilkinson's scapular osteotomy for Sprengel's shoulder were reported satisfactory without any neurological complications, we have experienced some cases of post-operative glenohumeral instability with downward rotation of the scapula. Here, we retrospectively investigated whether Wilkinson's osteotomy accelerated downward rotation of the scapulas. Eleven shoulders of 10 patients were reviewed for this study. Mean age at surgery was 6.2 ± 2.6 years old and mean follow-up term was 7.2 ± 5.9 years. The rotation angle of the scapula, range of shoulder motion and Cavendish grade were investigated. Rotation angle was defined as 0 degrees when glenoid was perpendicular to the horizontal line and upward rotation was defined as positive in direction. Mean rotation angle were -7.4 ± 6.5 degrees at the final follow-up, and -7.5 ± 8.0 degrees before operation. There was no significant difference. Shoulder motion and Cavendish grade were significantly improved. Among the 10 cases whose scapulas rotated downward, 2 patients (20.0%) showed symptomatic shoulder instability. Twelve years after the operation, multidirectional instability with limited range of motion due to pain was observed in a sixteen-year-old boy. Positional posterior subluxation and multidirectional instability were found in a five-year-old boy two years after the osteotomy. His symptom was improved at the final follow-up. We could not clarify whether Wilkinson's osteotomy accelerated downward rotation of the scapulas. We thought that a recent report of Mears' scapular osteotomy might resolve this problem.