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Revision after Instability Surgery

수술 후 재발한 견관절 불안정증의 치료

  • Kim, Paul Shinil (Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine) ;
  • Jo, Chris Hyunchul (Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine)
  • 김신일 (서울대학교 의과대학 서울대학교병원운영 서울특별시보라매병원 정형외과학교실) ;
  • 조현철 (서울대학교 의과대학 서울대학교병원운영 서울특별시보라매병원 정형외과학교실)
  • Received : 2017.07.31
  • Accepted : 2018.02.07
  • Published : 2020.10.30

Abstract

Recurrence is the most common complication after shoulder instability surgery, and the main causes of the postoperative recurrence of instability are trauma, misdiagnosis, and technical errors. The risk factors of recurrence may be classified as patient related, anatomical or technical. Causes of failure should be thoroughly evaluated by meticulous history taking, physical examination, and imaging studies, and followed by proper treatment of pathologic lesions. Nonoperative treatment should be considered initially in cases of recurred instability after shoulder instability surgery, but if this fails, repeated recurrence is prevented by performing appropriate anatomical reconstruction of ruptured Bankart lesions, capsular laxities, glenoid deficiencies and humeral head bone defects.

견관절 불안정증 수술의 가장 흔한 합병증은 불안정성의 재발이다. 견관절 불안정증 수술 후 불안정증 재발의 원인은 주로 외상, 부정확한 진단 및 술기상의 문제 등이 있으며 재발률을 높이는 위험인자로는 환자 요인과 해부학적 원인, 기술적 요인이 있다. 수술 실패의 원인을 세심한 병력 청취와 이학적 검사, 영상학적 검사 등으로 파악하여 원인 병변에 적절한 치료를 시행해야 한다. 수술 후 재발한 불안정증은 우선적으로 비수술적 치료를 고려해야 한다. 하지만 비수술적 치료가 실패한 경우 Bankart 병변의 파열, 관절막의 이완, 관절와 및 상완골 두의 결손에 따른 올바른 적응증을 가지고 적절한 치료 방법을 선택하여 가능한 해부학적 복원을 시행하여야 재발이 반복되는 것을 방지할 수 있을 것이다.

Keywords

References

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