Cuff tear arthropathy に対する人工骨頭置換術と広背筋移行術の成績

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Twenty-six patients underwent humeral head replacement (HHR) with or without tendon transfer for cuff tear arthropathy. There were 8 men and 18 women. The mean age was 70.1 years (58 to 81 years). Superior approach was used for the preservation of the coracoacromial arch and intact subscaplaris tendon. The smallest humeral head was selected for the possibility of rotator cuff repair. However, when rotator cuff remained in irreparable condition, latissimus dorsi tendon or pectoralis major tendon was transferred for cuff reconstruction. The patients were divided by 2 groups; 14 shoulders of HHR without tendon transfer and 12 shoulders of HHR with tendon transfer. Each patient was evaluated with Japan Orthopaedic Association score and Neers limited goals rating scale after a least 1 year of follow up. Thirteen patients were rated as successful and one as unsuccessful in the HHR without tendon transfer group. On the other hand, 10 patients were rated as successful and 2 as unsuccessful in the HHR with tendon transfer group. Postoperative active flexion in both groups statistically improved compared to preoperative active flexion. Although postoperative external rotation in the HHR with tendon transfer group improved compared to preoperative one, there was no significant difference of external rotation in the HHR group between pre and postoperative evaluation. There was no obvious nerve injury or deep infection. Temporary inferior subluxation was found in the HHR with tendon transfer group. The radiographic evaluation showed one case of glenoid erosion. The current results were consistent with the prior studies. Tendon transfer restored active external rotation but the results were imcomplete and variable. Improvement was better in case of severe preoperative active external rotation. Further study should be conducted on this point.
日本肩関節学会の論文

Cuff tear arthropathy に対する人工骨頭置換術と広背筋移行術の成績

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