ステップキャニュレーションシステムを用いた肩関節拘縮に対する関節鏡視下関節包切離術

Arthroscopic Capsular Release of Frozen Shoulder

　30名の肩関節拘縮例に関節鏡視下にステップキャニュレーションシステムを用いて関節包を関節窩側で全周性に切離した．最低経過観察期間は12カ月で，術前後の可動域，UCLA scoreを評価した．成績：術前の肩甲面挙上，下垂位外旋，下垂位内旋はそれぞれ平均73°，13.4°，L2で，術後は151.8°，55.4°，Th10.2に改善し，UCLA scoreは術前10.4点が術後32.2点に改善した．術後に明らかな合併症を呈した症例は認めなかった．結論：本手技により容易に肩関節包切離を施行できる．

　Arthroscopic capsular release was used to treat 30 patients with frozen shoulder. None of the patients had a trauma history, including shoulder fractures. Arthrography revealed reduced joint volume, but magnetic resonance imaging showed no evidence of rotator cuff tears. Capsular release was performed via anterior, posterosuperior, and posteroinferior (PI) working portals. The PI working portal was gradually enlarged by using the step cannulation system to avoid injuring the axillary nerve. The minimum follow-up period was 12 months. The average UCLA score was 10.4 points before surgery and 32.2 points at the final follow-up examination. Range of motion before surgery yielded the following average values：elevation 73 degrees；external rotation of the arm at the side, 13.4 degres；and internal rotation to the 2_nd lumbar vertebra；versus 152 degrees, 55.4 degrees, and to the 10.2_nd thoracic vertebra at the final follow-up examination. No complications were observed when the step cannulation system was used.