広範囲腱板断裂に対する大腿筋膜移植手技の検討と臨床成績

概要

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The purpose of this study was to clarify the merit of our operation method for a massive rotator cuff tear. If suturing by McLaughlins method after abrasion and traction of torn cuff provided insufficient covering of the humeral head, we chose fascial patch procedure using our standardized technique. In our protocols of patch procedure, the important points were sewed graft to the torn cuff edge firmly by the double mattress suture technique, anchored the tendon to the anatomical foot print of the major tuberosity, and removed an adequate thick graft with a single layer from the fascia. 28 operated patients with a massive rotator cuff tear were evaluated one year after operation. McLaughlins method was performed on 10 patients and fascial patch procedure was done in 18 patients. Repair integrity was estimated by Sugayas classification through MRI. The rate of healed case( Type I, II, III ) was 90% in McLaughlins method, and 92.9% in the patchprocedure. The mean JOA score improved from 62.1 to 90.6 in McLaughlins method, and from 56.9 to 90.3 in the patch procedure. All the cases returned to their jobs. A rate of successful anatomical healing rate must be respected as an index to judge whether operation methods are proper. Both of the rate and clinical outcome of our methods were satisfactory.