上腕骨人工骨頭置換術後 8 年で生じた反復性肩関節後方脱臼の一例

抄録

A 28 year-old woman developed a condition of the avascular necrosis of the right humeral head during treatment of SLE. The hemiarthroplasty was done in 1999. The JOA score was improved from 49.5 points preoperatively to 96 points postoperatively. October, 2007, she dislocated her right shoulder for the first time by turning over. A manual reduction under general anesthesia was done in our hospital on the same day. Her shoulder was fixed for 3 weeks in the nearly neutral position using our “M-sling”. February, 2008, when she stretched her hand toward her posterior-inferior direction, she dislocated her shoulder for the second time. July of the same year, when she took off cloths, her shoulder was dislocated for the third time. CT with air arthrogram showed no bone lesion but the leakage of the air from posterior capsule. On September 22nd in 2008, the operation was done. We found a slit of the infraspinatus and a seam of capsule and plicatied them. An iliac bone block was fixed with two screws for extension of the glenoid toward inferior-posterior. At 4 years after operation, her shoulder had not been dislocated and JOA score was 97 points. [conclusion] In this case, initial hemiarthroplasty had been good. It was useful for a case of RPDS with hemiarthroplasty to be operated in the inferior-posterior extension of the glenoid and the plication of posterior capsule.