高度な骨欠損を伴う反復性肩関節前方不安定症に対する鏡視下腸骨移植術

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Background: The purpose of this study is to evaluate the short term outcome after arthroscopic iliac bone grafting with capsulolabral reconstruction for shoulders with significant glenoid bone loss. Methods: Subjects consisted of 20 patients, including 18 males and 2 females, who underwent the index surgery and were followed for more than one year. The average age at surgery was 28 years old and the average follow-up period was 21.0 months. There were 14 primary and 6 revision surgeries. Iliac crest was harvested with the patients in the supine position under general anesthesia. Arthroscopic iliac bone grafting was then performed in the beach-chair position followed by capsulolabral reconstruction. In addition, rotator interval closure was performed as an augmentation. Postoperative outcomes including Rowe score and sports return, ROM, and 3DCT findings were evaluated at the final follow-up. Results: The postoperative average Rowe score improved significantly from 21.3 to 92.0. Sixteen out of 17 patients who were engaged in sports returned to their sports after surgery. Postoperative ROM was 170 degrees in elevation, 51 degrees in external rotation, and T10 in internal rotation. Postoperative 3DCT, which was performed more than one year after surgery, demonstrated optimal remodeling of the graft in 3, moderate remodeling and absorption in 4, and fair remodeling and distinct absorption in 3 patients. Graft position was strongly related with postoperative bone remodeling and absorption. No patients experienced re-dislocation after the index surgery. Conclusion: Although technically demanding, arthroscopic iliac bone grafting for shoulders with significant bone loss yielded successful outcomes with minimum morbidity.

高度な骨欠損を伴う反復性肩関節前方不安定症に対する鏡視下腸骨移植術

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