術前に軟部組織評価を行ったSprengel変形の1例

Sprengel's Deformity : Preoperative Evaluation of the Associated Soft Tissue Abnormalities : Case Report

　抄録：Sprengel変形では，肩甲骨，肩甲脊椎骨などの骨の異常のみならず軟部組織の異常を伴うことが多い．軟部組織の異常は治療成績に影響するので術前評価が重要である．しかし，われわれの渉猟しえた範囲では軟部組織を術前に評価した報告はない．症例は，著しい左肩関節可動域制限を伴う4歳女児である．術前のCT・MRIで僧帽筋，菱形筋の形成不全が認められ，術後の自動可動域の改善が不十分であることが予測された．術中所見および術後成績は術前予測と一致した．術前に軟部組織の異常を評価することは，術後治療成績の予測，術中遭遇する解剖学的異常に対処するうえで有用であった．

　Sprengel's deformity is often accompanied by soft tissue abnormalities as well as bone abnormalities, for example, in the scapula and omovertebral bone. Since the soft tissue abnormalities affect the outcome of treatment, preoperative evaluation is important. Nevertheless, a search of the literature yielded no reports on preoperative evaluation of soft tissue. A 4-year old girl presented with marked restriction of movement in the left shoulder. Preoperative CT and MRI revealed dysplasia of the trapezius and rhomboideus muscles, and it was predicted that any improvement in the range of active movement postoperatively would be inadequate. The intraoperative findings and postoperative outcome were consistent with the preoperative predictions. The preoperative evaluation of soft tissue abnormalities was useful in predicting postoperative outcome and in dealing with the anatomical abnormalities encountered during surgery.