結核性肩関節炎の臨床像　−12 例の検討−

概要

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Due to a drastic decrease of tuberculous disease, tuberculosis of the shoulder is rare in Japan recently. We retrospectively analyzed 12 patients with tuberculosis of the shoulder to assess its clinical problems. Before the patients were referred to our institution, 7 patients were misdiagnosed and treated. It took 18 months on average to make the final diagnosis. The delay of the diagnosis was often caused by a lack of severe symptom of the disease in its early stage. Consequently, prolonged duration of the disease caused an expansion of lesion, severe bony destruction and rotator cuff tear. We performed operations on 9 patients including curettage, curettage with bone grafting and resection arthroplasty. Wide curettage comprising of anterior and posterior approaches was often required for surgery, but complete curettage was sometimes difficult due to the location of lesion, such as the deep medial scapular region. Post-operative complications occurred in 2 cases including a death due to worsening of preexisting heart failure. Tuberculous lesions were successfully treated except for the deceased case. The mean forward elevation improved from 57.0 degrees at the 1st examination to 76.6 degrees at the latest follow-up. Patients with rotator cuff tear or severe bony destruction showed less favorable clinical results. Diagnosis and treatment of tuberculosis of the shoulder is still challenging for modern orthopaedic surgeons.