Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Medial Anterior-inferior Capsular Shift in Multidirectional Shoulder Instability

내측 전하방 관절낭 이동술을 이용한 다방향 견관절 불안정성의 치료

  • Chung, Soo-Tai (Department of Orthopaedic Surgery, Myongji Hospital, College of Medicine, Kwandong University) ;
  • Park, Jai-Hyung (Department of Orthopaedic Surgery, Myongji Hospital, College of Medicine, Kwandong University) ;
  • Kim, Hyoung-Soo (Department of Orthopaedic Surgery, Myongji Hospital, College of Medicine, Kwandong University) ;
  • Yoo, Jeong-Hyun (Department of Orthopaedic Surgery, Myongji Hospital, College of Medicine, Kwandong University) ;
  • Kim, Joo-Hak (Department of Orthopaedic Surgery, Myongji Hospital, College of Medicine, Kwandong University) ;
  • Ji, Jeong-Min (Department of Orthopaedic Surgery, Myongji Hospital, College of Medicine, Kwandong University) ;
  • Jo, Hwan-Hee (Department of Orthopaedic Surgery, Myongji Hospital, College of Medicine, Kwandong University)
  • 정수태 (관동대학교 의과대학 명지병원 정형외과학교실) ;
  • 박재형 (관동대학교 의과대학 명지병원 정형외과학교실) ;
  • 김형수 (관동대학교 의과대학 명지병원 정형외과학교실) ;
  • 유정현 (관동대학교 의과대학 명지병원 정형외과학교실) ;
  • 김주학 (관동대학교 의과대학 명지병원 정형외과학교실) ;
  • 지정민 (관동대학교 의과대학 명지병원 정형외과학교실) ;
  • 조환희 (관동대학교 의과대학 명지병원 정형외과학교실)
  • Published : 2007.06.15
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Abstract

Purpose: The purpose of this study was to prove the effectiveness of the open medial (glenoid-based) anterior-inferior capsular shift in patients with multidirectional shoulder instability. Materials and Methods: We reviewed 19 patients treated by medial anterior-inferior capsular shift for multidirectional shoulder instability from March, 1998 to December, 2003. 15 patients of them have experienced recurrent dislocation. 8 patients(42%) showed bilateral laxity and 11 patients(58%) generalized ligamentous laxity, and 2 patients(10.5%) voluntary subluxation. An average follow-up was 24 months (range : $9{\sim}32$ months). Results: Pain improved in 18 patients of all. There was an average loss of 10 degree of external rotation, but no limitation of activity of daily living. There was no redislocation and subluxation, but two patients had some apprehension in sports activity. With Rowe score, the result was excellent or good in all patients. There were hematoma and local skin problem in 1 patient, but all had healed up. Conclusion: Medial anterior-inferior capsular shift in multidirectional shoulder instability provided satisfactory results in pain relief, patient's satisfactions and stability of glenohumeral joint. Though some of them have anterior gleniod deformities and large Hill-Sachs lesions, we could get good stabilities.

목적: 이 논문의 목적은 다방향견관절 불안정증의 수술적 치료에 있어서 내측 전하방 관절낭 이동술의 유용성을 알아보고자 함이다. 대상 및 방법: 1998년 3월부터 2003년 12월까지 내측 전하방 관절낭 이동술을 시행한 19명의 환자를 대상으로 하였다. 이들 중 15례에서는 반복적인 탈구를 경험하였으며, 양측성 견관절에서만 이완을 보인 경우가 8례(42.0%), 견관절을 포함한 전신 인대 이완은 11례(58%)였으며 수의성 아탈구가 2례(10.5%)가 있었다. 평균 추시 기간은 24개월이었다(범위: 9-32 개월) 결과: 19례중 18례에서 통증이 호전되었으며, 평균 10도 정도의 외회전 감소가 있었으나 일상생활에 제한은 없었다. 술 후 모든 예에서 재탈구나 아탈구는 없었으나 2례에서는 스포츠 활동에서 불안감을 호소하였다. Rowe점수에서 모든 환자에서 최우수 또는 우수로 나타났으며 혈종 1례 및 가벼운 국소 피부 감염이 1례에서 있었으나 추후 모두 치료되었다. 결론: 다방향 견관절 불안정증에서 내측 전하방 관절낭 이동술은 통증감소, 환자의 만족도 및 견관절 안정성에 있어 만족스러운 결과를 나타냈다. Hill-Sachs병변 및 Bankart병변이 일부 있었으나 만족스러운 결과를 보였다.

Keywords

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