下方動揺性を伴う反復性肩関節脱臼の治療

抄録

[Purpose] We have obtained excellent clinical results with Boytchev's procedure for a r ecurrent dislocation of the shoulder. Few patients who had a preoperative inferior laxity complained of apprehension after this surgery. We operated on these patients with Boytchev's procedure and an anterior capsular shift without detachment of the subscapular tendon.
[Patients and Methods] This procedure was perform ed on 9 shoulders of 9 patients which had type II inferior laxity of Endo's classification. Their average age was 27.3 years old, and average follow-up period was 37 months. Four patients had general joint laxity of Carter's index 3/5 and all the patients except for one had inferior laxity in the contralateral side. The subscapularis was divided horizontally along the direction of its fiber at the lower one-third level and was never detached from the lessor tuberosity. Anterior capsular shift was performed through the divided interval of the subscapularis. After that, Boytchev's procedure was performed.
[Results ] Nothing of redislocation occurred, excep t for one subluxation. One shoulder revealed a positive anterior apprehension test. The average inferior laxity of the humeral head was 66 % preope ratively, and 33% postoperatively. The average restricted range of motion was 9 degrees in elevation,22 degrees in external rotation,19 degrees in horizontal external rotation,15 degrees in horizontal internal rotation. The average JOA score was 66 point preoperatively, and 88 points postoperatively.
[Conclusion] We can increase the tension of the subscapularis without d etachment of this tendon from the lesser tuberosity, and can perform an anterior capsular shift of the shoulder.