陳旧性肩関節後方脱臼に対しmodified McLaughlin法を施行した1例

抄録

A-37-year-old man received a hard blow on his right shoulder in a motor-vehicle accident. Pain and a restriction of shoulder motion lingered on in spite of conservative treatment under a diagnosis of humeral head fracture at a previous hospital for 7 months. When he was referred to Kyoto Prefectural University Hospital, his ranges of motion in the right shoulder were restricted to 135°flexion,120°abduction, and-35°external rotation; his JOA score was 56. Radiographs and CTs showed a posterior dislocation of the glenohumeral joint with anteromedial defect of the articular surface of the humeral head (chronic posterior dislocation). Surgery was performed 9 months after the trauma. A defect of the humeral head was caught in the posterior glenoid. Reduction of the dislocation and transfer of the lesser tuberosity onto the defect of the humeral head (modified McLaughlin's procedure) was performed. The shoulder was immobilized in the neutral position with a plaster cast for 3 weeks after surgery. At the point of 6 years after surgery, his ranges of motion were 120°fiexion,130°abduction, and 45°external rotation and his JOS score was 85. The patient was able to regain acceptable shoulder function by this procedure in spite of a neglected chronic dislocation for 9 months.