肩関節外傷性前方不安定症に対する Boytchev 変法とその併用手術について Modified Boytchev and its Combined Operation for Traumatic Unstable Shoulder
Modified Boytchev procedure was perfomed on 149 traumatic unstable Shoulders, and this procedure combined with a glenoid bone graft was perfomed on 12 shoulders that had over 20% of glenoid bone defect compared to the contralateral side, it was combined with a capsular shift in 17 shoulders that had an inferior laxity of Endo type II and III. The age ranged from 13 to 50 years (ave 23.7). The follow up period was 2 to 11 years (ave4). The balance between an insertion point to the conjoined tendon of the musculo-cutaneous nerve and the length of the tunnel under the subscapular tendon was measured in 62 Shoulders. The link between the occurrence rate of musculo-cutaneous nerve palsy and its insertion points were studied.<BR>The redislocation rate was 8.1% before changing the operative indication, and was 3.1% after it. Only one subluxation occurred after the capsular shift, but there was no recurrence after a glenoid bone graft. Twenty-three of the patients who underwent a modified Boytchev procedure, and 31% of the patients with a combined operation complained of slight pain during sports activity or heavy work. Ninety-six patients who wanted to play sports could do their original sport activity. Musuculocutaneous palsy occurred in 10% of the patients, but almost all the palsy recovered within 3 months. The length from the top of the coracoid process to the insertion of the musculo-cutaneous nerve should be 1.5cm longer than the tunnel of the subscapular tendon.
- 肩関節 = Shoulder joint
肩関節 = Shoulder joint 23(2), 327-331, 1999-07-30