外傷後に生じた位置性胸鎖関節後方亜脱臼に対し靱帯再建術を施行した１例

抄録

We reported a case of positional posterior sublaxation of the stenoclavicular joint, treated by ligamentous repair. A twenty year-old male's chest was hit in the practice of Japanese martial art. He had left stenoclavicular joint pain and instability, he visited our hospital after seven months. When he flexed his left shoulder to 120 degrees horizontally, posterior displacement of the medial end of the clavicle was noted, and when he abducted his shoulder back to 0 degree horizontal flexion position, the joint was reduced. X-ray didn't reveal stenoclavicular dislocation, CT showed posterior sublaxation of the stenoclavicular joint. We diagnosed this as traumatic positional posterior sublaxation of the stenoclavicular joint, and performed an operation which was reconstruction of the costoclavicular ligament and the stenooclavicular ligament using a musculous tensor fasciae latae. Untill 8 weeks after the operation, he put on the clavicle band and trained ROM and low loading isometric exercise. At twelve weeks postoperatively, the patient returned to the sport. Dislocation of the stenoclavicular joint is estimated to have a prevealence of 1% in all dislocations, and posterior dislocation of the stenoclavicular joint is rare. We can find 187 reports of acute traumatic posterior dislocation of the stenoclavicular joint, but can't find any reports of the operative treatment of positional posterior subluxation of the stenoclavicular joint. In this case, we think that due to rupture of the ligaments and posterior articular capsule, sublaxation was habitual. For the purpose of reconstruction of the costoclavicular ligament and the stenooclavicular ligament, we did the Lowman's method and Speed's method. The operation lead to early return to athletic activity.