肩関節
Online ISSN : 1881-6363
Print ISSN : 0910-4461
ISSN-L : 0910-4461
手術治療に難渋した肩腱板広範囲断裂の成績
名越 充橋詰 博行清水 弘毅
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ジャーナル フリー

2006 年 30 巻 3 号 p. 477-480

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It may not be possible to completely cover the humeral head with the rotator cuff tendon in old massive rotator cuff tears, because of the reduced flexibility of the cuff caused by muscle atrophy, fatty degeneration and a scarred cuff tendon. We reported on the surgical results, and the evaluation of post- operative cuff conditions by MRIs of a series of cases in which massive rotator cuff tears could not be completely reduced at the surgery. Twelve patients (11 men and 1 woman) underwent open surgery for massive rotator cuff tears. The patients'mean age was 58.7 years old. All the cases were seen as chronic large deltoid cuff tears and the cuff stumps were severely retracted. We used Nobuhara's technique in the antero-lateral approach. We confirmed the type of tear after release of the adhesion on the rotator cuff (sometimes added under the cuff). In 8 cases (A group)both anterior and posterior portion were reduced by this method and anchored into the bone groove, which was dug 10-15 mm proximally from the original position. In 4 cases (B group), only the anterior part was repaired because we were unable to out the posterior. The surgical results were evaluated according to JOA score. The conditions of the anterior and posterior portions of the repaired cuff tendon was examined by MRI (Ti, T2, oblique sagittal, oblique coronal) at the follow up. We divided the cuff tendon into four conditions according to their thickness and evaluated the relation between the clinical results and cuff condition. The mean follow up period was 49.2 months. JOA score improved from 51.2-92.2 points. The A group's scores were superior to B group's scores in abduction power and staying power. The anterior portion of the repaired cuff tendon was confirmed by post operative MRI in the A group, and in 3 patients in the B group. The posterior portion could be confirmed in 4 cases in the A group, but in none in the B group. We were able to get good results in incomplete repair cases. Even if the scarred cuff was anchored at the proximal area from the original position, and if only anterior portion was repaired, this procedure was meaningful to improve the shoulder function.

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© 日本肩関節学会
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