動揺性肩関節症に対する鳥ロ突起上方移行術の経験

抄録

In most cases with multidirectional instabilities of shoulder joints, it seems unable to identify the causative factors or secondary lesions, which makes radical surgical approaches for this kind of instability very difficult. In this paper we report on a new dynamic suspension operation from which satisfactory results were obtained.
The coracoid process with conjoined tendo n s of the short head and coracobrachial muscle was transferred superiorly to the clavicle so as to pull up the humerus. This coracoid transfer was combined with other procedures, such as the shortening of the long head, reconstruction of the coracohumeral ligament with the coracoacromial ligament transfer and the Putti-Platt procedure.
The most rigid stability was obtained when we combined operations of the coracoid transfer passed through the subscapularis and the shortening of the long head.
If the coracoid is passed through the horizontal slit made in the upper one third of the subscapular muscle, the lower part of the subscapularis will serve as a muscular buttress to prevent anterior dislocation, and the upper part does not allow the humeral head to slip posteriorly or laterally as the arm is elevated. The long head acts as a guide rope to lead the humeral head toward the center of the glenoid fossa, and its loosening, in fact, as observed in all cases arthroscopically, will enhance multidirectional instability. The tightened long head efficiently prevents lateral slipping with the shoulder in abduction. The merit of this operation is that the anterior approach can be applied also to the posterior instability as described above.