肩甲骨関節窩骨欠損を伴う肩関節前方不安定症に対する
Bankart-Latarjet 法の治療成績

抄録

The purpose of this study was to evaluate the clinical results of Bankart-Latarjet procedure for anterior shoulder instability with significant glenoid defect. During the period between 2000 and 2006, high demand patients underwent Bankart-Latarjet procedure for traumatic anterior shoulder instability with greater than 25% glenoid bone loss and we could follow up on 12 cases for more than 2 years after the surgeries. In operation, we first performed transosseous Bankart repair, and transferred the coracoid process, laid flat on the glenoid neck with 2 cancellous screws. We assessed postoperative complications, active shoulder range of motion, and clinical results evaluated by JSS instability score and Rowe score. With a mean follow-up time of 6.0 years, none of these patients showed any recurrent instability. The transferred coracoid process had united in all cases and there was no evidence of fracture nor absorption. Two cases showed osteoarthritic advancement of the glenohumeral joint. Active elevation and external rotation significantly increased after the surgeries (p < 0.05). Compared with the contralateral side, however, external rotation was limited by 10.6° with the arm at the side and 5.6° with the arm abducted at 90°. The mean JSS instability score had been 50.6 preoperatively and improved to 92.0 at the time of final follow-up (p < 0.05). Rowe score had also significantly improved from 39.2 to 91.3 (p < 0.05). Satisfactory outcomes were achieved by Bankart-Latarjet procedure for traumatic anterior shoulder instability with glenoid defect. Postoperative limited range of external rotation might be caused by relative shortening of the anterior capsule following glenoid defect. To assess the postoperative osteoarthritic change, we should follow the cases long term.