肩関節拘縮に対する鏡視下授動術の臨床成績
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Here we report clinical outcomes of cases of arthroscopic surgery including those complicated by diabetes mellitus. Arthroscopic surgery was performed on 13 shoulders of 13 patients (seven men, six women, six patients with complications of diabetes mellitus) with primary contracture that had not improved with conservative therapy performed at our hospital for more than three months. Postoperative clinical outcomes were measured using JOA score. The mean JOA scores were 51.9 in the non-diabetes group (group A) and 52.8 in the diabetes group (group B) preoperatively, and 92.9 in group A and 83.7 in group B postoperatively. The largest difference between groups A and B was in range of motion. Many clinicians may have seen that shoulder joint contracture is often refractory in patients with the complication of diabetes mellitus. Although the joint capsule was removed in the same manner, the range of motion in group B was more limited than that in group A under anesthesia, resulting in a smaller range of motion in group B at the final follow-up after surgery. This was attributed to contraction of not only the glenohumeral joint but also the scapulothoracic joint and others in group B. It was thought that a movable decrease of the sternoclavicular joint strongly took part. However, considering a marked improvement in pain score of JOA measured postoperatively, surgery may be adequately effective in group B also. The clinical outcomes after arthroscopic surgery were favorable in cases with contraction that had not been improved with conservative therapy.
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