反復性肩関節脱臼・亜脱臼に対するModified Inferior Capsular Shift法:前方関節包縫縮時の外旋角度の手術成績への影響

抄録

(Purpose) The purpose of this study was to evaluate the operative results depending on the external rotation angle at capsulorrhaphy.
(Materials & methods) Seventy-seven shoulders(56 men and 21 women)were examined clinically and with CYBEX testing. The minimum follow-up was one year(average 2.7 years)after a modified inferior capsular shift(MICS)procedure. The average age at surgery was 18.7 years. Preoperatively,7shoulders(9%)showed concomitant inferior instability. Capulorrhaphy was performed with the external rotation angle at 10 degrees in 43 shoulders(10-group)and at more than 25 degrees in 34 shoulders(25group).
(Result) One recurrence occurred in an epileptic patient(1.5%). External rotations were examined in the anatomical and at 90 degrees abduction positions. The average limitations of external rotation on the operated side in both the 10-and 25-groups in the latter position were 14.8 and 5,0 degrees, which were not statistically different from each other. In the CYBEX testing, the peak torque rations(peak torque of the operated side/peak torque of the non-operated side)were greater in the 25-group than the 10-group in external rotation at both 30 degrees and 90 degrees of abduction(t-test, P<0.01).
(Conclusions) MICS procedure was excellent in controlling recurrent anterior instability of the shoulder. However, the postoperative range of external rotation can be increased by an altered rehabilitation program and the position of immobilization.