腱板断裂を伴う肩関節拘縮の病態 (第2報) : - 拘縮様式と臨床成績 -

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The purpose of this study was to evaluate the surgical results of rotator cuff tears which received brisement procedures for preoperative shoulder contractures. Twenty-six shoulders of 26 patients who received brisement procedures prior to cuff surgeries were followed-up over one and a half years. There were 22 males and 4 females, aged from 37 to 75 years old (mean 57 years old). There were 4 massive, 4 large, 12 small and 6 partial thickness tears.Operations were performed at 6 months on average (1-11 months) after the onset of the symptoms. They were followed-up for 29 months on average (18-45 months) after surgery. According to the arthroscopic findings, there were two types of capsular injuries by brisement procedures. Type A : tear of the axillar region, Type B : tear of both the axillar and rotator interval regions. The outcome was assessed with the JOA score and the transition of ranges of motion. The factors that influence the degree of preoperative contractures were also analyzed. Each parameter was statistically analyzed by SPSS (p<0.05). Postoperative shoulder functions improved significantly in both types. The average total JOA score increased from 62.1 to 89.6 (p<0.001) in type A and from 57.8 to 89.2 (p<0.001) in type B. The range of passive flexion changed from 99° to 167° in type A, while it moved from 96° to 166° in type B. The range of passive abduction changed from 93° to 166° in type A, while it moved from 89° to 169° in type B. The most significant difference between type A and type B was found in the range of external rotation, which moved from 44° to 44° in type A, and 29° to 45° in type B. Flexion and abduction improved by the brisement procedures and were maintained. But, the range of external rotation which had been increased by brisement procedures could not be kept in the post-operative course. The results were not affected by age, tear types, nor follow-up period. The range of motion before surgery was influenced by the patients age and duration of symptoms. Rotator cuff tears which received brisement procedures for pre-operative shoulder contractures had good surgical results. The improvement of range of motion in external rotation gained more in those shoulders which had had disrupted capsules at both the axillar and rotator interval regions.
日本肩関節学会の論文

腱板断裂を伴う肩関節拘縮の病態 (第2報) : - 拘縮様式と臨床成績 -

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