修復不能な肩甲下筋腱断裂に対する大胸筋移行術の手術成績

概要

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The purpose of this study was to evaluate the short term outcome of pectoralis major transfer carried out in three shoulders that had irreparable subscapularis tears. Three patients that underwent pectoralis major transfer between January, 2008 and November, 2008 were used. There were 3 males. The mean age was 62 years old and the average follow-up period was 14.6 months. The mean active flexion was 95° preoperatively, abduction 90°, ER 52°, IR sacrum and the average JOA score was 58.7 points. All patients showed positive lift-off test and belly-press test. All patients had a massive tear of subscapularis, supraspinatus and infraspinatus tendons. Preoperative magnetic resonance imaging revealed retraction of the subscapularis musculotendinous unit to the glenoid and fatty infiltration of the subscapularis muscle of grade IV. The proximal half tendon of pectoralis major muscle was released from its insertion and fixed to the distal aspect of the greater tuberosity using transosseous suture technique. The tendons of supraspinatus and infraspinatus were repaired to the greater tuberosity with suture anchors. The mean active flexion was 153° postoperatively, abduction 137°, ER 67°, IR L4/5 and the average JOA score was 84.7 points.Lift-off test and belly-press test remained positive in all three patients. Pectoralis major transfer results in improvement for patients with an irreparable subscapularis tear.