初回外傷性肩関節前方脱臼に対する強内旋位固定法

Immobilization in the Wrist-lumbar Position after Primary Traumatic Anterior Shoulder Dislocation

　初回外傷性肩関節前方脱臼に対して，強内旋位での関節唇の観察をMRIにて行い，それによる知見により考案した強内旋位固定で治療を行った2例を経験したので報告する．脱臼整復後に内旋位と外旋位，そして強内旋位にてMRIを施行した．強内旋位は前腕を腰部に回した肢位をとらせる．内旋位でも外旋位でも剝離した関節唇を密着させることができていなかったが，強内旋位では肩甲下筋腱が関節唇をちょうど関節窩縁に押さえ込み，密着整復させていた．経過は良好で，2年以上経過しても再脱臼を起こしていない．

　We examined two patients with primary traumatic anterior shoulder dislocation by MRI and treated them by a new conservative method of therapy. After reduction the glenoid labrum was examined by plain MR imaging in internal rotation and external rotation, and in greater internal rotation by positioning the wrist on the lumbar. Separation of the labrum was observed in both internal rotation and external rotation. In the wrist-lumdar position the subscapularis muscle kept the labrum closely on the edge of the glenoid fossa. The patients were treated conservatively by immobilization of the shoulder in the wrist-lumbar position for three weeks. No separation of the labrum, recurrence of the dislocation or instability of the shoulder has occurred during a follow-up period of more than two years.