鏡視下腱板修復術における腋窩神経損傷に関する検討

概要

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Background: We reported good clinical results of an original anchorless arthroscopic rotator cuff repair (arthroscopic transosseous suture repair of the rotator cuff: ATOS). Meanwhile we pointed out axillary nerve (AN) injury because of a blind maneuver when making an entry hole for the Kirshcner wires (K wire). Methods: 41 shoulders were included in the study from October 2010 to March 2011. 19 male and 24 female patients (mean age 65 years old) were evaluated. Three bursal side tear, 19 small tears, 16 medium tears, four large tears, and a massive tear were involved. When four weeks passed after a surgery, the activity of the deltoid muscle was measured by an electromyogram and the value of the integral of the waveform was obtained. Moreover, we measured distances, (A) between the acromion and the entry hole of the K wire, and (B) between the great tuberosity (GT) and the entry hole of the K wire by using MR images. Results: Deltoid muscle activity was found in all shoulders. The distance of (A) was42mm, and (B) was 20.1mm. Discussion: This result showed that ATOS never develop axillary nerve injuries. Gardner reported that the axillary nerve was 6.3cm from the acromion. In this study, it was demonstrated that the entry hole of the K wire of ATOS was set far from the AN, so any maneuver of ATOS would never develop an AN injury. Moreover, to reduce the possibility of AN injury, we made the tip of this aiming guide dull.