Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
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Large Hill-Sachs Lesion Combined with a Rotator Cuff Tear in an Acute Traumatic Anterior Dislocation of the Shoulder in an Elderly Patient Treated with an Allogenic Iliac Tricortical Bone Graft

노인 환자의 급성 외상성 견관절 전방 탈구에서 회전근개 파열과 동반된 거대 Hill-Sachs 병변에 대해 간접 정복 및 지지대 목적의 동종 장골 삼중 피질골 이식을 통한 치료 1예

  • Hyun, Yoonsuk (Department of Orthopaedic Surgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Lim, Jinkyu (Department of Orthopaedic Surgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Baek, Seung-Ha (Department of Orthopaedic Surgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Park, Jinho (Department of Orthopaedic Surgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Lee, Seung-Jin (Department of Orthopaedic Surgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine)
  • 현윤석 (한림대학교 의과대학 강동성심병원 정형외과학교실) ;
  • 임진규 (한림대학교 의과대학 강동성심병원 정형외과학교실) ;
  • 백승하 (한림대학교 의과대학 강동성심병원 정형외과학교실) ;
  • 박진호 (한림대학교 의과대학 강동성심병원 정형외과학교실) ;
  • 이승진 (한림대학교 의과대학 강동성심병원 정형외과학교실)
  • Received : 2018.08.05
  • Accepted : 2019.10.15
  • Published : 2020.04.30
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Abstract

An indirect reduction through the bicipital groove and allogenic iliac tricortical bone graft was performed as a treatment for a large Hill-Sachs lesion with a rotator cuff tear in an acute traumatic shoulder joint dislocation in an elderly patient. Six months after surgery, the rotator cuff healing and bone union were confirmed. The patient also showed satisfactory clinical results with 95 points of the American Shoulder and Elbow Surgeons (ASES) shoulder score and active range of motion with 155° flexion, 120° abduction, and 70° external rotation and 30° internal rotation at 90° abduction. The surgical method can be considered for a large Hill-Sachs lesion with rotator cuff tear in an acute traumatic shoulder joint dislocation in elderly patients.

본 증례에서는 노인 환자에 발생한 견관절의 급성 외상성 전방 탈구에서 회전근개 파열과 동반되어 생긴 거대 Hill-Sachs 병변에 대한 치료법으로 상완 이두근 구를 통한 간접 정복과 동종 장골 삼중 피질골 이식을 시행하였다. 수술 후 6개월째, 회전근개의 치유 및 골유합을 확인하였다. 또한 American Shoulder and Elbow Surgeons (ASES) shoulder score 95점, 전방 능동 거상 155도, 외전 120도, 외전 90도에서 외회전 70도와 내회전 30도의 운동 범위로 만족스러운 임상결과를 보였다. 노인 환자에 발생한 견관절의 급성 외상성 전방 탈구에서 회전근개의 파열과 동반된 거대 Hill-Sachs 병변 대해 본 수술 방법을 고려해 볼 수 있을 것이다.

Keywords

References

  1. Chen AL, Hunt SA, Hawkins RJ, Zuckerman JD. Management of bone loss associated with recurrent anterior glenohumeral instability. Am J Sports Med. 2005;33:912-25. https://doi.org/10.1177/0363546505277074
  2. Longo UG, Loppini M, Rizzello G, et al. Remplissage, humeral osteochondral grafts, weber osteotomy, and shoulder arthroplasty for the management of humeral bone defects in shoulder instability: systematic review and quantitative synthesis of the literature. Arthroscopy. 2014;30:1650-66. https://doi.org/10.1016/j.arthro.2014.06.010
  3. 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. 2000;16:677-94. https://doi.org/10.1053/jars.2000.17715
  4. Kazel MD, Sekiya JK, Greene JA, Bruker CT. Percutaneous correction (humeroplasty) of humeral head defects (Hill-Sachs) associated with anterior shoulder instability: a cadaveric study. Arthroscopy. 2005;21:1473-8. https://doi.org/10.1016/j.arthro.2005.09.004
  5. Re P, Gallo RA, Richmond JC. Transhumeral head plasty for large Hill-Sachs lesions. Arthroscopy. 2006;22:798.e1-4. https://doi.org/10.1016/j.arthro.2005.12.038
  6. Mehta V. Humeral head plasty for a chronic locked anterior shoulder dislocation. Orthopedics. 2009;32:52. https://doi.org/10.3928/01477447-20090915-61