長期透析患者の肩関節痛に対する内視鏡下烏口肩峰靱帯切離術の長期成績

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Shoulder pain induced by dialysis-related amyloidosis is one of the most frequent lesions that occur in long-term haemodialysis patients. We thought that the main cause of shoulder pain was the increase of subacromial pressure induced by the amyloid deposit in the subacromial bursa and rotator cuff, and have performed endoscopic coraco-acromial ligament release (ECLR) with a view of the decompression of the subacromial space. We considered pathogenesis of this lesion by investigating the course after ECLR over 5 years and comparing them with the preoperative image and clinical findings. 28 men (32 shoulders) and 40 women (56 shoulders) who had been having dialysis for an average of 18.7 years were operated on. ECLR was performed under local anesthesia in all cases. The follow-up mean period was 6.7years. We evaluated the results according to the JOA score and compared them with the ultrasonograpic changes. We also investigated the recurrent rate and additional operation. The average JOA improved from 65.3 to 88.7 at 1 month after operation, but became worse at the last follow up (80.6). The recurrent rate was 17.0%. Additional ECLR was needed in 6cases, open subacromial bursectomy in 2cases, arthriscopic synovectomy in 5 cases and arthroplasty in 2cases. ECLR was not effective in 8 cases. Cervical laminoplasty was required in 3 cases. Although the subacromial lesion is the main cause of the shoulder pain in long-term haemodialysis patients, attention to advanced shoulder arthropathy, recurrence and cervical lesions must be paid.
日本肩関節学会の論文

長期透析患者の肩関節痛に対する内視鏡下烏口肩峰靱帯切離術の長期成績

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