反復性肩関節脱臼にみられる関節症性変化 : 第2報 Degenerative Glenohumeral Arthrosis following Recurrent Anterior Dislocation of the Shoulder
Degenerative glenohumeral arthrosis was detected in untreated or postoperative patients with recurrent anterior shoulder dislocation (RASD) by radiographic examination. Previously we reported that 31.7%of the preoperative 246 RASD patients with an average 4.7 years from initial dislocation had an osteophyte detected on the anteroinferior margin of the humeral head by CT-pneumoarthrography, and the existence of early arthrotic change was correlated with the number and the frequency of subluxations. The aim of this study was to search for degenerative glenohumeral arthrosis of postoperative patients.<BR>113 shoulders (110 patients) with RASD with the Bankart operation were reviewed at an average 7.6year (range,5 to 13) postoperative follow-up. The average-age at the follow-up was 31.5 years (range,21 to 67). The radiographs (anteroposterior, axillary lateral and 45° cephalocaudal view) of operated shoulders showed an osteophyte on the anteroinferior margin of the humeral head in 17 (15.0%) shoulders. The age at the follow-up, the age at the operation, the age at the initial dislocation, the interval between the operation and the follow-up, the interval between the initial dislocation and the follow-up, and the amount of limitation of shoulder elevation, internal rotation, external rotationand external rotation with the arm abducted 90° at the follow-up were compared between 17 shoulders with an osteophyte and 96 shoulders without an osteophyte. Statistical analysis of the data using Mann-Whitney's U test revealed that the age at the follow-up, operation and initial dislocation were significantly (p<0.05) higher in shoulders with an osteophyte. It was noted by reviewing CT-pneumoarthrography preoperatively that 13 shoulders (76.5%) in 17 with an osteophyte, and 15shoulders (15.6%) in 96 without an osteophyte had the osteophyte detected on the anteroinferior margin of the humeral head before surgery.<BR>15.0% of postoperative RASD had radiographic evidence of glenohumeral arthrosis, but the preoperative CT showed that 76.5% of the arthrosis already existed before surgery. It was suggested that the risk factor of development of arthrosis existed as a preoperative factor, which was the age at the initial dislocation, and the effect of surgery to the development and progression of the arthrosis is relatively low.
- 肩関節 = Shoulder joint
肩関節 = Shoulder joint 24(2), 217-220, 2000-07-31