有痛性麻痺性肩関節亜脱臼に対し鏡視下安定化手術を行った 1 例
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概要
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We report a case of painful paralytic shoulder subluxation treated successfully by arthroscopic Stabilization. A 54 year-old female with athetoid cerebral palsy. She had cervical spondylotic amyotrophy due to the involuntary movements associated with athetoid cerebral palsy. She had difficulty in elevating her right shoulder for 30 years. She also appeared in pain from passive shoulder movement for 10 years. Conservative treatment was performed at other hospitals, such as the use of a sling, but the gradual increase in pain led to her first visit to our hospital. Significant muscle atrophy and weakness showed in deltoid SSP ISP and biceps. Shoulder active elevation was impossible. Downward shoulder subluxation was shown in X-ray images. CT image did not show glenoid hypoplasia or bone loss, or bony changes of the humeral head. Pain was relieved by maintaining the position of the humeral head by manual reduction. It was thought that by performing surgery to keep reduction we could expect improvement in the symptoms. Arthroscopic surgery was performed. Plication to 1 cm between the posterior capsule and the labrum. The anterior labrum was detached from the glenoid and sutured according to suture anchor method while pulling superiorly. In addition rotator interval closure was performed. A sling was used during the first 2 weeks after surgery. Pain disappeared soon after surgery. At 1 year after surgery, reduction position of humeral head in X-ray images and improvement of pain was maintained. Arthroscopic stabilization for painful paralytic shoulder subluxation is considered a useful method for improvement of pain.