肩関節不安定症における Load & shift 検査と肩甲骨関節窩骨欠損の関係

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Background: To investigate the effect of the glenoid bone-deficit for shoulder stability, we examined the correlation between the load-and-shift (LAS) test and the glenoid bone-deficit in patients with recurrent dislocation of shoulder (RDS). Methods: 24 patients who underwent surgery for RDS with glenoid bone-deficit between 2007 and 2010 were studied. Under general anesthesia, the LAS test at 45°, 90° and 120° shoulder abduction (LAS45, LAS90, LAS120) was performed by an examiner and each LAS-point (0-3) according to Hawkins' classification(0-3)was recorded. Using CT-image, we calculated the glenoid width ratio and divided the morphology of bone-deficit into "avulsion type (A-group)" and "compression type (C-group)". Results: Mean LAS-point was high in the order of LAS90(2.58), LAS45(1.29) and LAS120(1.00). As well as bone-deficit size, mean LAS-point in A-group was significantly higher than that in C-group at LAS90, but was lower at LAS120. Mean glenoid width ratio was 77.1% (A-group), 85.6% (C-group) and 81.0% (whole group). Significant correlation between LAS-point and glenoid width ratio was seen at LAS90 in C-group and whole group. Discussion: Although the bone-deficit in C-group was smaller than in A-group, the point of LAS120 in C-group was higher than A-group. These results suggest that it was because the humeral head and glenoid contact on different areas, and the ligament restriction of the anterior translation of humeral head is also different at different glenohumeral abduction angles. About the correlation between LAS-point and glenoid width ratio, we speculate that it was because LAS-point does not increase more than three points even if the bone-deficit is larger.

肩関節不安定症における Load & shift 検査と肩甲骨関節窩骨欠損の関係

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