広範囲腱板断裂に対する拡大経肩峰アプローチ

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Usually, surgical results of McLaughlins procedure for a rotator cuff tear are excellent. But, sometimes, it is difficult to detect the cuff stump or it is impossible to suture it, due to a massive rotator cuff tear. We reported on the surgical results of patients with a massive rotator cuff tear, which were sutured through the new trans-acromial approach. Five men and one woman were sutured a torn cuff through the new trans-acromial approach, It was impossible to suture the patients with conventional Neer approach. The base of the acromion was dissected with a T-saw vertical to the spine of the scapula. After the osteotomy and the sprit of the acromio-clavicular joint, the acromion was turned over. It was very easy to release the cuff stump and the capsule surrounding the glenoid. After suturing the cuff stump to the bony trough on the humeral head, the acromion was fixed with a pin wire (Zimmer co.). The average follow-up was 14 months. The average width of the cuff was 5 cm, and its average length was 6 cm. The ranges of motion of the shoulder and the JOA scores were studied before and after the surgery. The averages 70 degrees of elevation, 37 degrees of external rotation, L1 of internal rotation before surgery. The average 130 degrees of elevation, 30 degrees of external rotation, L2 of internal rotation after surgery. The average pain score had improved from 11 points to 25 points, the average JOA score was 56 points before surgery, and 81 points after it. Delayed union of the acromion was observed in 2 patients, and irritation of the pin was in one. Three patients had difficulty to reach the opposite shoulder with their hand, one patient could not adduct her arm. The new trans-acromial approach is a useful procedure for a massive rotator cuff tear.
日本肩関節学会の論文
2002-01-01

広範囲腱板断裂に対する拡大経肩峰アプローチ

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