リウマチ肩に対する人工肩関節置換術の成績

抄録

Fourteen patients with rheumatoid shoulder underwent prosthetic arthroplasties over the last seven years. The results of prosthetic arthroplasties in 12 patients on whon a follow-up study could be made more than one year after surgery were evaluated by the J. O. A. score.
These patients consisted of 4 males and 8 females and the age at the time of operation ranged from 46 to 72 years. The follow-up period after the operation ranged from one year to 6 years and 4 months. A single modular total shoulder arthroplasty system (Biomodular Total Shoulder System, Biomet, Warsaw, Ind. ) was used in each case. All polyethylene glenoid components were implanted with cement. In 7 Shoulders, humeral stems were inserted by the press-fit technique. At follow-up period each patient was evaluated according to the J. O. A. score. The rotator cuff tear was torn in 6 patients. The results were excellent in one case, good in 4 cases, fair in 5 cases and 2 patients had poor result. A remarkable relief of pain was observed in most of the patients. Range of motion improved 50° in forward elevation. In the analysis, functional results of the prosthetic arthroplasty depend on the status of deltoid muscle rather than that of rotator cuff (p<O.05).
A modular total shoulder system provides better adjustment to the soft-tissue tension on the shoulder joint and better results than non-modular shoulder arthroplasty.