長期透析患者の肩関節障害に対する手術成績

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Dialysis-related amyloidosis has been a serious complication that significantly adds to the morbidity of long-term dialysis patients. Shoulder pain is the initial symptom in 25-50% of cases, but is not completely relieved by rest. The clinical results of surgical treatment for dialysis-related amyloidosis of the shoulder were evaluated. Surgical treatment was attempted after failing to improve with at least three months of conservative therapy that included rehabilitation and the use of an oral non-steroidal anti-inflammatory agent. Twenty-eight shoulders of 24 patients (11 females and 13 males) were evaluated according to the Japanese Orthopaedic Association (JOA) shoulder score. The average age of the patients was 63.4 years old, and the average duration of follow-up was 37.6 months. The surgical procedures included 26 arthroscopic debridements, 5 rotator cuff repairs, 2 arthroscopic manipulations, 2 bone grafting for large cyst of the humeral head, 1 hemiarthroplasty and 1 total shoulder arthroplasty. Overall JOA scores improved from 55.8 preoperatively to 79.7 postoperatively. In cases with rotator cuff tear, JOA scores improved from a mean preoperative score of 38.8 and 60.0 to mean postoperative score of 65.1 and 93.6 in those with and without cuff repair, respectively. The group treated with rotator cuff repair had statistically significantly improved shoulder function compared to the group treated debridement alone. As well as removal of the amyloid, anatomical repair depending on clinical condition is required.

長期透析患者の肩関節障害に対する手術成績

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