Clinics in Shoulder and Elbow

대한견·주관절의학회 (Korean Shoulder and Elbow Society)
권호 표지
DOI QR코드

DOI QR Code

견갑하근 단독 손상 시 시행한 관절경하 봉합 나사를 이용한 봉합술

Arthroscopic Treatment with Suture Anchor for the Isolated Subscapularis Tear

  • 문영래 (조선대학교 의과대학 정형외과학교실) ;
  • 안기용 (조선대학교 의과대학 정형외과학교실)
  • Moon, Young-Lae (Department of Orthopaedic Surgery, College of Medicine, Chosun University) ;
  • An, Ki-Yong (Department of Orthopaedic Surgery, College of Medicine, Chosun University)
  • 발행 : 2009.12.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 회전근 개의 하나인 견갑하근 단독 손상 시 봉합나사를 이용한 파열부 봉합술에 대해 문헌 고찰과 함께 그 결과를 알아보고자 한다. 대상 및 방법: 2001년 2월부터 2007년 10월까지 본원에서 견갑하근의 단독손상에 대해 봉합나사를 이용한 관절경적 처치를 시행한 29명의 환자를 대상으로 하였다. 전례에서 다른 회전근 개의 손상이 없는 견갑하근 단독 손상이었고, 견갑하근 손상의 범위는 상부 1/3인 경우가 19예, 상부 2/3인 경우가 7예, 완전 파열인 경우가 3예 였다. 평균 추시 기간은 12.2개월 (6~26개월) 이었다. 결과의 판정은 최초 내원 시점과 최종 추시의 constant shoulder score 결과를 비교하였다. 결과: 술후 constant shoulder score 는 술 전 평균 $49.9\pm7.3$ 에서 술 후 평균 $73.8\pm3.0$으로 constant shoulder score 중 pain points 는 술 전 평균 $4.3\pm3.2$ 에서 술 후 평균 $11.2\pm3.0$으로 향상되었다. 결론: 견갑하근의 단독손상 시 봉합나사를 이용한 견갑하근 봉합술은 좋은 치료방법 중 하나로 고려할 수 있다.

Purpose: We wanted to evaluate the results of arthroscopic management of an isolated rupture of the subscapularis tendon using suture anchors. Materials and Methods: Twenty nine patients with unilateral ruptures of the subscapularis tendon and who underwent arthroscopic repair between February 2001 and October 2007 were reviewed prospectively. All the cases were isolated tears of the subscapularis without the involvement of any other rotator cuff tendon. In 19 patients the tear was localized to the superior one third, in 7 cases the tear was localized to the upper two thirds and the entire tendon was involved in 3 cases. The mean follow up period was 12.2 months (range: 6-26 months). The results of the treatment were assessed by evaluating the constant shoulder score and the pain score before surgery and after surgery. Results: The constant shoulder score improved from $49.9\pm7.3$ to $73.8\pm3.0$ points compared to before surgery and the pain score improved from $4.3\pm3.2$ to $11.2\pm3.0$ points postoperatively. Conclusion: Arthroscopic repair of isolated ruptures of the subscapularis tendon using suture anchors is a good option for effectively managing these tears.

키워드

참고문헌

  1. Adams CR, Schoolfield JD, Burkhart SS: The results of arthroscopic subscapularis tendon repairs. Arthroscopy, 24: 1381-1389, 2008. https://doi.org/10.1016/j.arthro.2008.08.004
  2. Bennett WF: Arthroscopic repair of anterosuperior (supraspinatus/subscapularis) rotator cuff tears: a prospective cohort with 2- to 4-year follow-up. Classification of biceps subluxation/instability. Arthroscopy, 19: 21-33, 2003.
  3. Burkhart SS, Tehrany AM: Arthroscopic subscapularis tendon repair: Technique and preliminary results. Arthroscopy, 18: 454-463, 2002. https://doi.org/10.1053/jars.2002.30648
  4. Deutsch A, Altchek DW, Veltri DM, Potter HG, Warren RF: Traumatic tears of the subscapularis tendon. Clinical diagnosis, magnetic resonance imaging findings, and operative treatment. Am J Sports Med, 25: 13-22, 1997. https://doi.org/10.1177/036354659702500104
  5. Flury MP, John M, Goldhahn J, Schwyzer HK, Simmen BR: Rupture of the subscapularis tendon (isolated or in combination with supraspinatus tear): when is a repair indicated- J Shoulder Elbow Surg, 15: 659-664, 2006. https://doi.org/10.1016/j.jse.2005.07.013
  6. Gerber C, Hersche O, Farron A: Isolated rupture of the subscapularis tendon. J Bone Joint Surg Am, 78: 1015-1023, 1996.
  7. Gerber C, Krushell RJ: Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg Br, 73: 389-394, 1991.
  8. Ide J, Tokiyoshi A, Hirose J, Mizuta H: An anatomic study of the subscapularis insertion to the humerus: the subscapularis footprint. Arthroscopy, 24: 749-753, 2008. https://doi.org/10.1016/j.arthro.2008.02.009
  9. Inman VT, Saunders JB, Abbott LC: Observations of the function of the shoulder joint. 1944. Clin Orthop Relat Res, 330: 3-12, 1996. https://doi.org/10.1097/00003086-199609000-00002
  10. Kim SH, Oh I, Park JS, Shin SK, Jeong WK: Intraarticular repair of an isolated partial articular-surface tear of the subscapularis tendon. Am J Sports Med, 33: 1825-1830, 2005. https://doi.org/10.1177/0363546505278259
  11. Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R: Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapu- laris tears. J Bone Joint Surg Am, 89: 1184-1193, 2007. https://doi.org/10.2106/JBJS.F.00007
  12. Lo IK, Burkhart SS: The etiology and assessment of subscapularis tendon tears: a case for subcoracoid impingement, the roller-wringer effect, and TUFF lesions of the subscapularis. Arthroscopy, 19: 1142- 1150, 2003. https://doi.org/10.1016/j.arthro.2003.10.024
  13. Pfirrmann CW, Zanetti M, Weishaupt D, Gerber C, Hodler J: Subscapularis tendon tears: detection and grading at MR arthrography. Radiology, 213: 709-714, 1999. https://doi.org/10.1148/radiology.213.3.r99dc03709
  14. Smith J: Pathological appearance of seven cases of injury of the shoulder joint, with remarks. Laondon Med Gaz, 14: 280, 1834.
  15. Ticker JB, Warner JJ: Single-tendon tears of the rotator cuff. Evaluation and treatment of subscapularis tears and principles of treatment for supraspinatus tears. Orthop Clin North Am, 28: 99-116, 1997. https://doi.org/10.1016/S0030-5898(05)70268-6
  16. Tung GA, Yoo DC, Levine SM, Brody JM, Green A: Subscapularis tendon tear: primary and associated signs on MRI. J Comput Assist Tomogr, 25: 417-424, 2001. https://doi.org/10.1097/00004728-200105000-00015
  17. Warner JJ, Higgins L, Parsons IMt, Dowdy P: Diagnosis and treatment of anterosuperior rotator cuff tears. J Shoulder Elbow Surg, 10: 37-46, 2001. https://doi.org/10.1067/mse.2001.112022

피인용 문헌

  1. MR Evaluation of Tendinous Portions in the Subscapularis Muscle vol.14, pp.1, 2011, https://doi.org/10.5397/CiSE.2011.14.1.035