外傷性肩関節前方不安定症の直視下手術後再発例に対する鏡視下手術の検討

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Generally, open revision surgery is considered as a standard procedure for failed open shoulder stabilization. However, we prefer arthroscopic surgery to open for revision because arthroscopy enables us easy access to the glenohumeral joint even after preceding open surgeries and precise repair of the glenohumeral pathologies. Therefore, we performed arthroscopic revision surgery for all shoulders after failed glenohumeral stabilization regardless of primary methods.We performed 10 revision arthroscopic stabilizations following failed open surgeries. They were nine males and a female with an average age of 31 years old (range, 17 to 47) at the time of revision surgeries. The primary stabilization methods of these patients included open Bankart repair in 4, Boytchev procedure in 4, modified Bristow procedure in 1 and modified Oudard-Iwahara-Yamamoto procedure in one shoulder. We found a Bankart lesion in all 10 cases. They underwent ordinary arthroscopic Bankart procedure using suture anchors without any difficulties. We performed rotator interval closure as an augmentation in seven cases. Currently, no further failure was observed in 9 of 10 cases. 9 patients were classified as excellent or good using Rowe sore. JOA shoulder score was significantly improved. A 44-year-old-man was reinjured with a medium glenoid fracture during wake-boarding.Since a Bankart lesion was observed in all cases and 7 patients underwent a recurrent instability within one year without a traumatic event, the pathology for failed open stabilization was believed to be an inadequate technique during primary surgery or problem of the primary procedure itself. We think arthroscopic surgery is a suitable for the revision of failed open stabilization because an approach to the glenohumeral joint is easy despite extra-articular adhesion or scar formation caused by primary open surgery, also, glenohumeral joint structure was well preserved in most shoulders. In conclusion, arthroscopic revision surgery was effective for failed open stabilization.
日本肩関節学会の論文
2009-07-27

外傷性肩関節前方不安定症の直視下手術後再発例に対する鏡視下手術の検討

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