外傷性肩関節(亜)脱臼の無作為比較試験 : 直視下vs鏡視下手術

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To clarify the relative effectiveness of modified Neers inferior capsular shift (MICS) as open procedure and arthroscopic Bankart repair (AB), we compared these 2 methods in a randomized controlled study. We investigated 28 shoulders of 27 patients (males 21, females 6) for the MICS (13 shoulders of 12 patients) and AB (15 shoulders of 15 patients). The average follow-up was 27 months (range, 24-37 months). 3 bioabsorbable anchors were used for Bankart repair in both operations. No augmentations such as rotator interval closure or capsular shrinkage were added to AB. Clinical evaluation included rate of recurrent instability, range of motion and period of rehabilitation after surgery. All patients were assessed by the scoring systems of Rowe and UCLA preoperatively and at the final evaluation. The rates of recurrent instability were not significantly different between the MICS (0 %) and AB (3 patients, 20 %) (p=0.067). Limitation of elevation in AB was smaller than in MICS at 3 months after surgery (p<0.05). Furthermore, limitation of external rotation at 90° abduction in AB was smaller than in MICS at 3, 6, 12 and over 24 months after surgery (p<0.05). Further, period of postoperative rehabilitation in AB (ave. 16 weeks) was shorter than in MICS (ave. 25 weeks) (p<0.01). The mean JOA sports and Rowe scores of both procedures were not significantly different at final follow-up. Our data suggested that MICS yielded less recurrent instability than AB. The JOA sports and Rowe scores were not significantly different between 2 procedures at final follow-up. However, AB recovered faster than MICS with less limited external rotation.
日本肩関節学会の論文
2008-06-30

外傷性肩関節(亜)脱臼の無作為比較試験 : 直視下vs鏡視下手術

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