Clinics in Shoulder and Elbow

대한견·주관절의학회 (Korean Shoulder and Elbow Society)
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외상으로 인한 재발성 단방향 견관절 후방 아탈구의 관절경을 이용한 후방낭 이동술

Arthroscopic Posterior Capsular Shaft for Traumatic Recurrent Unidirectional Posterior Subluxation of the Shoulder

  • 김승호 (성균관대학교 의과대학 삼성서울병원 정형외과학교실) ;
  • 하권익 (성균관대학교 의과대학 삼성서울병원 정형외과학교실) ;
  • 유재철 (을지대학교 의과대학 을지병원 정형외과학교실) ;
  • 이용석 (성균관대학교 의과대학 삼성서울병원 정형외과학교실) ;
  • 이희동 (을지대학교 의과대학 을지병원 정형외과학교실)
  • Kim, Seung-Ho (Department of Orthopaedic Surgery, Samsung Medical Center, Sunkyunkwan University School of Medicine) ;
  • Ha, Kwon-Ick (Department of Orthopaedic Surgery, Samsung Medical Center, Sunkyunkwan University School of Medicine) ;
  • Yoo, Jae-Chul (Department of Orthopaedir Surgery, Eulji Hospital, Eulji University School of Medicine) ;
  • Lee, Yong-Seuk (Department of Orthopaedic Surgery, Samsung Medical Center, Sunkyunkwan University School of Medicine) ;
  • Lee, Hui-Dong (Department of Orthopaedir Surgery, Eulji Hospital, Eulji University School of Medicine)
  • 발행 : 2003.06.01
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초록

Background: The purpose of this study was to evaluated results of arthroscopic treatment of the traumatic recurrent unidirectional posterior subluxation. Materials and Methods: We treated twenty-seven patients who had traumatic recurrent unidirectional posterior subluxation of the shoulder by arthroscopic labral repair and posterior capsular shift and prospectively evaluated for a mean of thirty-nine months (range,24 to 85 months). Patients who had posteroinferior instability, multidirectional instability, atraumatic onset, or revision cases were excluded. There were twenty-five male and two female patients with the mean age of twenty-one years (range, 14 to 33 years). All patients were involved in sports activity. All had a significant traumatic event prior to the onset of the instability. Stability, motion, three objective measurement (UCLA, ASES, and Rowe scores) and two subjective measurements (pain and function visual analogue scale) were evaluated. Results: The most common finding in magnetic resonance image-arthrogram was separation of the posteroinferior labrum without displacement in 9 patients, In arthroscopic examination, all patients had one or more lesions in the posterior inferior labrum and capsule. The most common finding was incomplete stripping of the posterior inferior labrum (18 patients). The posteroinferior capsule subjectively appeared to be stretched in twenty-two patients. At follow-up, all patients had improved shoulder function and scores(p < 0.01). All patients had stable shoulder by subjectivel and objectivel measurements, except one patient who had recurrent subluxation. All but one patient with postoperative recurrence were able to return to their prior sports activity with little or no limitation. Twenty-four patients were graded as having more than 90％ of shoulder function. Their were twenty-one excellent, five good, and one fair UCLA. scores. Pain sore improved from 4.5 to 0.2 point(p : 0.0001). Mean loss internal rotation was one vertebral level. None had operative complications. Conclusion: In conclusion, treatment outcomes of the traumatic unidirectional recurrent posterior subluxation are consistently reliable with respect to the stability, pain relief, and functional restoration by the arthroscopic posterior capsular shift procedure.

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참고문헌

  1. Petersen SA: Poaterior shoulder instability. Orthop Clin North Am 2000;31:263-74. https://doi.org/10.1016/S0030-5898(05)70146-2
  2. Hawkins RJ, McCormack RG: Posterior shoulder instability. Orthopedics 1988; 11:10 1-7.
  3. Fronek J, Warren RF, Bowen M: Posterior subluxation of the glenohumeral joint. J Bone Joint Surg Am. 1989;71:205-16.
  4. Antonion J, Duckworth DT, Harryman DT 2nd: Capsulolabral augmentation for the management of postroinferior instability of the shoulder. J Bone Joint Surg Am. 2000;82:1220-30.
  5. Fuchs B, Jost B, Gerber C: Posterior-inferior capsular shift for the treatment of recurrent, voluntary posterior subluxation of the shoulder. J Bone Joint Surg Am. 2000;82:16-25.
  6. McIntyre LF, Caspari RB, Savoie FH 3rd: The arthroscopic treatment of posterior shoulder instability: two-year results of a multiple suture technique. Arthroscopy. 1997;13:426-32. https://doi.org/10.1016/S0749-8063(97)90119-5
  7. Bigliani LU, Pollock RG, McIlveen SJ, Endrizzi DP, Flatow EL: Shift of the posteroinferior aspect of the capsule for recurrent posterior glenohumeral instability. J Bone Joint Surg Am 1995;77:1011-20.
  8. Hawkins RJ, Janda DH: Posterior instability of the glenohumeral jont. A technique of repair Am J Sports Med 1996;24:275-8. https://doi.org/10.1177/036354659602400305
  9. Misamore GW, Facibene WA: Posterior capsulorrhaphy for the treatment of traumatic recurrent posterior subluxations of the shoulder in athletes. J Shoulder Elbow Surg. 2000;9:403-8. https://doi.org/10.1067/mse.2000.108963
  10. Tibone JE, Bradley JP: The treatment of posterior subluxation in athletes. Clin Orthop. 1993;291:124-37.
  11. Hurley JA, Anderson TE, Dear W, Andrish JT, Bergfeld JA, Weiker GG: Posteri or shoulder instability: surgical versus conservative results with evaluation of glenoid version. Am J Sports Med. 1992;20:396-400. https://doi.org/10.1177/036354659202000405
  12. Neer, C.S., II, and Foster, C.R.: Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. Apreliminary report. J Bone Joint Surg Am 1980;62:897-908.
  13. Pollock RG, Bigliani LU: Recurrent posterior shoulder instability. Diagnosis and Treatment. Clin Orthop 1993;291:85-96.
  14. Schwartz E, Warren RF, O'Brien SJ and Fronek J: Poaterior shoulder instability. Orthop Clin North Am 1987;18:409-19.
  15. Tibone J and Ting A: Capsulorrhaphy with a staple for recurrent posterior subluxation of the shoulder. J Bone Joint Surg Am. 1990;72:999-1002.
  16. Bowen M, Warren RF: Surigical approaches to podterior instability of the shoulder. OperTech Sports Med. 1993;1:301-10.
  17. Wolf EM, Eakin CL: Arthroscopic capsular plication for posterior shoulder instability. Arthroscopy. 1998;14:153-63. https://doi.org/10.1016/S0749-8063(98)70034-9
  18. Kim S-H, Ha K-I: SMC knot -A new slip knot wih locking mechanism. Arthroscopy. 2000;16:563-5. https://doi.org/10.1053/jars.2000.4821
  19. Kim S-H, Ha K-I, Kim J-S: Significance of the internal locking mechanism for loop security enhancement in the arthroscopic knot. Arthroscopy. 2000;17:850-5.
  20. Boublik M, Silliman JF: History and physical examination. In: Hawkins RJ, Misamore GW, editor. Shoulder injuries in the athlete. New York: Churchill Livingstone; 1996.p9-22.
  21. Blasier RB, Soslosky LJ, Malicky DM, Palmer ML: Posterior glenohumeral subluxation; Active and passive stabilization in a biomechanical model. J Bone Joint Surg Am. 1997;79:433-40. https://doi.org/10.1302/0301-620X.79B3.7394
  22. Neer CS 2nd, Welsh RP: The shoulder in sports. Orthop Clin North Am 1997;8:583-591.
  23. Ellman H, Hanker G, Bayer M: Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Srug. 1986;68:1136-44.
  24. Richard RR, An KN, Biglian LU, Friedman RJ, Gartsman GM, Gristina AG, Iannotti JP, Mow VC, Siedle JA: A standard method for the assessment of shoulder function. J Bone Joint Surg. 1994;60:1-52.
  25. Rowe CR, Patel D, Southmayd WW: The Bankart procedure. Along term end result study. J Bone Joint Srug. 1978;60:1-16.
  26. Scott J, Huskisson EC: Graphic representation of pain. Pain. 1976;2:175-84. https://doi.org/10.1016/0304-3959(76)90113-5
  27. Kim S-H, Ha K-I: Arthroscopic treatment of symptomatic shoulders with minimally displaced greater tuberosity fracture. Arthroscopy. 2000;7:695-700.
  28. Altchek DW, Warren RF, Skyhar MJ, Oritz G: T-plasty modification of the Bankart procedure for multidirectional instability of the anterior and inferior types. J Bone Joint Srug Am. 1991;73:105-12.
  29. Burkhead W, Rockwood C: Treatment of instability of the shoulder with an exercise program. J Bone Joint Srug Am. 1992;74:890-6.
  30. Goss TP, Costello G: Recurrent symptomatic posterior glenohumeral subluxation. Orthop Rev. 1988;17:1024-32.
  31. Hawkins RJ and Belle RM: Posterior instability of the shoulder. In Instructional Course Lectures, American Academy of Orthopaedic Surgeons, 1989.
  32. Antoniou J, Harryman DT 2nd: Arthroscopic posterior capsular repair. Clin Sports Medicine. 2000;19:101-14. https://doi.org/10.1016/S0278-5919(05)70298-2
  33. Wirth MA, Groh GI, Rockwood CA Jr: Capsulorrhaphy through an anterior approach for the treatment of atraumatic posterior glenohumeral instability with multidirectional laxity of the shoulder. J Bone Joint Srug Am 1998;80:1570-8.
  34. Warren RF, Kornblatt IB, Marchaud R: Static factors affecting posterior shoulder stability. Orthop Trans. 1894;8:89.
  35. Harryman DT, Sdles JA, Harris SL, Matsen FA: The role of the rotator interval in passive motion and stabiluity of the shoulder. J Bone Joint Srug. 1992;74:53-66.