安全な5 o'clock ポータル作成の工夫 －エコーガイドの利用－

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Background: Bankart's lesion is usually treated using suture anchors through an anterior portal. In some cases, it can be difficult to insert suture anchors at the inferior part of the glenoid via an anterior portal. In these situations or for management of humeral avulsion of the glenohumeral ligament lesion, a 5 o'clock portal needs to be made for inserting suture anchors. Methods: Intra-operative ultrasound of the shoulder is introduced as a new method to establish the 5 o'clock portal for the treatment of traumatic anterior shoulder instability. The cephalic vein, the coracoid process and the conjoined tendon were marked using ultrasound before operation under general anesthesia in the lateral decubitus position. After standard arthroscopic release of anterior labrum or bony Bankart's lesion, the 5 o'clock portal was established using a slalom technique under ultrasound guidance in outside-in fashion. We inserted suture anchors and headless screws through this portal into the antero-inferior part of the glenoid. Results: In four shoulders of four patients with a mean age of 26.0 years, arthroscopic Bankart or bony Bankart repair was performed. In all shoulders, we were able to establish the 5 o'clock portal using a slalom technique under ultrasound guidance in outside-in fashion. There were no complications. Discussion: Because this portal is usually established using a blind slalom technique, some neurovascular structures, especially the cephalic vein and musculocutaneous nerve, can be at risk. We could visualize the route of cannula during placement of the portal and establish the portal safely and reliably under ultrasound guidance.

安全な5 o'clock ポータル作成の工夫<BR>－エコーガイドの利用－

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