修復不能な腱板断裂を伴う肩関節症に対する人工骨頭置換術と筋腱移行術の成績

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Patients who had pain and dysfunction from glenohumeral arthritis accompanied with irreparable rotator cuff tear had few treatment options. Recently, reverse shoulder prosthesis was reported in the management of this problem. However, the high complication rate was one of the problems in this procedure. The purpose of this study was to investigate the clinical results after hemiarthroplasty with a tendon muscle transfer in patients with glenohumeral arthritis accompanied with severe rotator cuff deficiency. We investigated 13 consecutive patients (mean age: 65 years old) who were followed-up for more than 1 year postoperatively. There were 7 patients with rheumatoid arthritis. Pectoralis major transfer was performed in 6 cases, latissimus dorsi transfer was performed in 6 cases, and combined transfer of both tendons was performed in 1 case in addition to hemiarthroplasty of the humerus. The post operative mean JOA scores were 63.3, 74.7, and 87.5 in the pectoralis major transfer, latissimus dorsi transfer, and combined tendon transfer group, respectively. The mean flexions of the shoulder were 62.5°, 116.7°, and 150°, respectively. There were no cases of infection, nerve injury, or dislocation. A hemiarthroplasty with a latissimus dorsi transfer could provide satisfactory results in patients with glenohumeral arthritis with irreparable rotator cuff tear. Although a hemiarthroplasty with a pectoralis major transfer could provide good pain relief, flexions of the shoulder were limited and unsatisfactory. Weaknesses of muscle strength associated with rheumatoid arthritis and anterosuperior instability during flexion are considered as reasons for poor results.
日本肩関節学会の論文
2008-06-30

修復不能な腱板断裂を伴う肩関節症に対する人工骨頭置換術と筋腱移行術の成績

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