小結節骨切りによるアプローチで施行した人工肩関節置換術の検討

概要

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Background: Lesser tuberosity osteotomy (LTO) was proposed by Gerber et al. in 2005 to prevent possible subscapularis dysfunction after subscapularis tenotomy during total shoulder arthroplasty (TSA). We have utilized LTO for TSA and hemiarthroplasty since 2009. The purpose of this study was to evaluate the short-term outcome of TSA using LTO and to investigate intraoperative problems related with LTO. Methods: Nine cases of TSA were performed between 2009 and 2011. There were 2 men and 7 women, and the mean age at surgery was 77.3 years old. Osteoarthritis was present in 7 cases and rheumatoid arthritis in 2 cases. All patients were followed-up for at least 1 year and the mean follow-up period was 24 months. Clinical outcome was evaluated using JOA score and range of shoulder motion, and intraoperative problems were investigated through operative records. Results: JOA score significantly improved from 44.6 points preoperatively to 80.2 points at the most recent follow-up, and the range of flexion and external rotation also significantly improved from 71.7° to 115.6° and from -0.6° to 30.0°, respectively. During surgery, anterior aspect of osteotomised medullary canal was nearly broken in 1 case because humeral stem was impacted too anteriorly. In this case, LTO was repaired with bone grafting harvested from humeral head. There was no other complication related with LTO. Conclusion: LTO was useful approach during TSA.
日本肩関節学会の論文