非外傷性肩関節不安定症に対する鏡視下安定化手術の術後成績

抄録

The purpose of this study was to examine the clinical results of arthroscopic stabilization for atraumatic shoulder instability. We retrospectively analyzed 44 shoulders of 42 patients who had been operated for atraumatic shoulder instability. The mean age at operation was 23.0 years old and the mean follow-up period was 25.5 months. We evaluated the direction and degree of instability by examination both in the awake condition and under anesthesia, and performed arthroscopic stabilization using some procedures, including thermal capsular shrinkage, labral repair, plication of the capsule, rotator interval closure and so on. With respect to the direction of instability, we classified atraumatic instability into four types: anterosuperior instability (18 shoulders), anteroinferior (11 shoulders), posterior (7 shoulders), and multidirectional (8 shoulders). The clinical results were assessed by JSS Shoulder Instability Score, recurrent ratio and return to sports participation. The average JSS Shoulder Instability Score after the operation was 89.0 points. The score of shoulders with anterosuperior instability improved from 68.9 to 90.7, anteroinferior from 65.8 to 93.2, posterior from 65.1 to 88.6, and multidirectional from 55.9 to 82.4. Seven shoulders(18.4%) had recurrent instability. A return to sports participation was noted in 92% of 25 patients. The postoperative JSS Shoulder Instaility Score was lower in patients with posterior or multidirectional instability than anterosuperior or anteroinferior one. Of 7 shoulders with recurrent instability, six were treated by thermal capsular shrinkage. Thermal capsular shrinkage was suggested to be an unreliable procedure.