Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Arthroscopic Stabilization Using Remplissage Technique In Recurrent Shoulder Instability with Large Hill-Sachs Lesion - Minimum Six Months Follow-Up Results -

광범위한 Hill-Sachs 병변에서 Remplissage 술기를 이용한 관절경적 재건술 - 최소 6개월 이상 추시 결과 -

  • Ko, Sang-Hun (Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Jung, Kwang-Hwan (Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Jeon, Hyung-Min (Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Park, Han-Chang (Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine)
  • 고상훈 (울산대학교 의과대학 울산대학교병원 정형외과학교실) ;
  • 정광환 (울산대학교 의과대학 울산대학교병원 정형외과학교실) ;
  • 전형민 (울산대학교 의과대학 울산대학교병원 정형외과학교실) ;
  • 박한창 (울산대학교 의과대학 울산대학교병원 정형외과학교실)
  • Received : 2010.04.27
  • Accepted : 2010.05.11
  • Published : 2010.06.15
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Abstract

Purpose: To evaluate shoulder stability, clinical, and functional results more than 6 months after utilizing the 'Remplissage' technique, consisting of an arthroscopic posterior capsulodesis and infraspinatus tenodesis, to fill Hill-Sachs lesions. Materials and Methods: Seven patients were followed-up more than 6 months after the 'Remplissage' procedures performed in our hospital from August 2008 to August 2009. The mean age of the patients was 28.6 years and the mean follow-up time was 10 months. Evaluations included ROM, ASES score, KSSI score, ROWE score, and postoperative MRI. Results: In a functional evaluation of the patients with an average postoperative time of 10 months, the ASES score improved from 51.4 preoperatively to 76.8 postoperatively, the KSSI score improved from 46.5 preoperatively to 76 postoperatively, and the ROWE score improved from 43.5 preoperatively to 76.3 postoperatively. After an average postoperative time of 10 months, the range of motion was nearly normal (>170 degrees in further flexion, and >45 degrees in external rotation). Conclusion: In recurrent shoulder instabilities with large Hill-Sachs lesions, the 'Remplissage' technique resulted in good outcomes in terms of shoulder stability, clinical, and functional results after postoperative times of more than 6 months.

목적: 재발성 견관절 불안정성에 대한 관절경 하 후방 관절낭 유합술과 극하근 건 고정술로 이루어진 'Remplissage' 술기를 이용한 Hill-Sachs 병변 복원술을 시행 후 최소 6개월 이상 추시가가능하였던 환자들의 견관절의 안정성 및 임상적, 기능적 결과를 평가하고자 하였다. 재료 및 방법: 2008년 8월부터 2009년 8월까지 본원에서 시술된 'Remplissage' 술기를 시행하였던 7예를 대상으로 하였다. 평균 연령은 28.6세였으며 전 례에서 남성이었고, 평균 추시 기간은 10개월이었다. 평가는 견관절의 운동 범위, ASES 점수, KSSI 점수, ROWE 점수, 그리고 술 후 자기공명영상 촬영을 포함하였다. 결과: 술 후 평균 10개월에 견관절 기능적 평가에서 ASES 점수는 술 전 평균 51.4점에서 술 후 평균 76.8점으로, KSSI 점수는 술 전 평균 46.5점에서 술 후 평균 76점으로, ROWE 점수는 술 전 평균 43.5점에서 술 후 평균 76.3점으로 각각 향상되었고, 모든 환자에서 견관절 운동범위는 전방 거상 170도 이상이었으며, 외회전은 45도 이상으로 나타났다. 결론: 광범위한 Hill-Sachs 병변이 동반된 재발성 견관절 불안정성에 대한 'Remplissage' 술기를 시행 후 6개월 이상 추시 결과 견관절의 안정성 및 임상적, 기능적으로 양호한 결과를 보여주었다.

Keywords

References

  1. Burkhart SS, De Beer JF: Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: Significance of the inverted pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy, 16: 677-694, 2000. https://doi.org/10.1053/jars.2000.17715
  2. Chapovsky F, Kelly JD IV: Osteochondral allograft transplantation for treatment of glenohumeral instability. Arthroscopy, 21: 1007e1-4, 2005.
  3. Cheng SL, Mackay MB, Richards RR: Treatment of locked posterior fracture-dislocations of the shoulder by total shoulder arthroplasty. J Shoulder Elbow Surg, 6: 11-17, 1997. https://doi.org/10.1016/S1058-2746(97)90065-3
  4. Connolly JF: Humeral head defects associated with shoulder dislocation - Their diagnostic and surgical significance. Instr Course Lect, 21: 42-54, 1972.
  5. Deutsch AA, Kroll DG: Decreased range of motion following arthroscopic remplissage. Orthopedics, 31: 492, 2008.
  6. Flatow EL, Warner JI: Instability of the shoulder: complex problems and failed repairs: Part I. Relevant biomechanics, multidirectional instability, and severe glenoid loss. Instr Course Lect, 47: 97-112, 1998.
  7. Gerber C, Lambert SM: Allograft reconstruction of segmental defects of the humeral head for the treatment of chronic locked posterior dislocation of the shoulder. J Bone Joint Surg Am, 78: 376-382, 1996.
  8. Green A, Norris TR: Shoulder arthroplasty for advanced glenohumeral arthritis after anterior instability repair. J Shoulder Elbow Surg, 10: 539-545, 2001. https://doi.org/10.1067/mse.2001.118007
  9. Hill HA, Sachs MD: The grooved defect of the humeral head. Radiology, 35: 690-700, 1940. https://doi.org/10.1148/35.6.690
  10. Ko SH, Park KB: Arthroscopic Technique of Bone Defect in Anterior Shoulder Instability. J Korean Shoulder Elbow Soc, 12: 102-108, 2009. https://doi.org/10.5397/CiSE.2009.12.1.102
  11. Koo SS, Burkhart SS, Ochoa E: Arthroscopic Double- Pulley Remplissage Technique for Engaging Hill- Sachs Lesions in Anterior Shoulder Instability Repairs. Arthroscopy, 25: 1343-1348, 2009. https://doi.org/10.1016/j.arthro.2009.06.011
  12. Krackhardt T, Schewe B, Albrecht D, Weise K: Arthroscopic fixation of the subscapularis tendon in the reverse Hill-Sachs lesion for traumatic unidirectional posterior dislocation of the shoulder. Arthroscopy, 22: 227-227, 2006.
  13. Kropf EJ, Sekiya JK: Osteoarticular allograft transplantation for large humeral head defects in glenohumeral instability. Arthroscopy, 23: 322.e1-5, 2007. https://doi.org/10.1016/j.arthro.2006.07.032
  14. Lafosse L, Lejeune E, Bouchard A, Kakuda C, Gobezie R, Kochhar T: The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability. Arthroscopy, 23: 1242-1242, 2007.
  15. Lee BG, Rhee YG: Open Techniques for Bone Defect in Anterior Shoulder Instability. J Korean Shoulder Elbow Soc, 12: 255-263, 2009. https://doi.org/10.5397/CiSE.2009.12.2.255
  16. Lee YG, Jo NS, Jo SH: Radiologic Characteristics of Engaging Hill-Sachs Lesion on Three-Dimensional Reconstruction CT. Academic Congress Korean Shoulder Elbow Soc, 23: 23-24, 2009.
  17. Palmer I, Widen A: The bone block method for recurrent dislocation of the shoulder joint. J Bone Joint Surg Br, 30: 53-58, 1948.
  18. Pritchett JW, Clark JM: Prosthetic replacement for chronic unreduced dislocations of the shoulder. Clin Orthop Relat Res, 216: 89-93, 1987.
  19. Purchase RJ, Wolf EM, Hobgood ER, Pollock ME, Smalley CC: Hill-Sachs “Remplissage”: An Arthroscopic Solution for the Engaging Hill-Sachs Lesion. Arthroscopy, 24: 723-726, 2008. https://doi.org/10.1016/j.arthro.2008.03.015
  20. Re P, Gallo RA, Richmond JC: Transhumeral head plasty for large Hill-Sachs lesions. Arthroscopy, 22:798.e1-4, 2006. https://doi.org/10.1016/j.arthro.2005.12.038
  21. Tae SK: What Should We Treat For Recurrent Dislocation? J Korean Shoulder Elbow Soc, 7: 1-4, 2004. https://doi.org/10.5397/CiSE.2004.7.1.001
  22. Weber BG, Simpson LA, Hardegger F: Rotational humeral osteotomy for recurrent anterior dislocation of the shoulder associated with a large Hill-Sachs lesion. J Bone Joint Surg Am, 66: 1443-1450, 1984.

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