腱板広範囲断裂に伴う肩関節血腫に対する鏡視下手術を施行した2例

Hemarthrosis of the Shoulder with Massive Rotator Cuff Tear Treated by Arthroscopic Surgery. Report of Two Cases

　肩関節血腫は血友病，神経障害性関節症，関節リウマチ，cuff tear arthropathy，軟骨石灰化症，腫瘍，色素性絨毛結節性滑膜炎が原因で生じることがある．このうち，腱板断裂に伴う肩関節血腫の報告は極めて少ない．われわれは保存療法に抵抗する腱板広範囲断裂に伴う肩関節血腫の2例に対し鏡視下手術を行った．出血源は滑膜および骨髄であり，2例とも鏡視下に止血が可能であった．2例とも高血圧症の治療を受けていた．血腫形成以降，不安定となっていた血圧は，術後に肩の疼痛が軽快するとともに安定した．疼痛や関節血腫の再燃はみられていない．

　Hemarthrosis of the shoulder with rotator cuff tear is a rare condition, and its etiology is not well understood. We treated two cases of hemarthrosis of the shoulder with rotator cuff tear by arthroscopic surgery. Active bleeding was observed from the synovium or bone marrow of the humeral head, whose cartilage was worn down. Hemostasis was achieved arthroscopically by electrocautery. Mechanical stress may be involved in the process of hemarthrosis formation. Both patients were free of shoulder pain after surgery, but active range of motion was restricted. Both patients were being treated for high blood pressure, but as the pain in their shoulder decreased, their poor blood pressure control improved.