鏡視下腱板縫合術中に肩甲下動脈損傷を生じた1例

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We experienced an extremely rare case of intra-operative subscapular arterial injury in arthroscopic rotator cuff repair. A 78- year- old male complained of right shoulder pain for 9 months. Physical examination revealed positive impingement sign and positive lift-off test. CT arthrography and MRI showed full-thickness tears of supraspinatus and subscapularis tendon. He was given an intra-articular corticosteroid injection and oral NSAIDs. However, the persistant shoulder pain remained. He underwent arthroscopic surgery in August 2009. Arthroscopic findings included a severe retracted tear of subscapularis tendon. Arterial bleeding appeared during mobilization of torn subscapularis tendon using a shaver. This bleeding was coagulated by the arthroscopy pump and radiofluency device. Arterial bleeding appeared again in open rotator cuff repair but, the bleeding was stopped by pressure hemostasis. After the operation, a large number of transfusions were performed, but, vital status was unstable. The patient was transferred to the Emergency Department the day after the surgery. Subscapular artery injury was diagnosed and treated by Intervention Radiology. Acute renal failure appeared because of much contrast medium and hemorrhagic shock. He underwent emergency dialysis. Although he could be removed from dialysis, septic arthritis of the shoulder appeared 4 weeks after the surgery. The organism was MRSA. We performed direct debridement immediately. But, we could not get complete healing. So, we performed arthroscopic synovectomy. At 14-month follow-up, the septic process has not returned.There is no report of the intra-operative subscapular arterial injury during arthroscopic rotator cuff repair to our knowledge.

鏡視下腱板縫合術中に肩甲下動脈損傷を生じた1例

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