重度な不安定性を呈した高齢者反復性肩関節脱臼の1例

Traumatic Severe Anterior Instability of the Shoulder in an Elderly Patient. Case Report

　症例は67歳の男性で，主訴は右肩関節脱臼不安感であった．脚立より右肩から転落し受傷した．保存的に経過観察したが，脱臼不安感のため内旋位から肩を動かせなかった．術前JOAスコアは33点であった．画像上，関節窩縦計20％のbony Bankart病変と骨頭頂に達する大きなHill-Sachs損傷，広範囲腱板断裂を認めた．手術は鏡視下にbony Bankart病変の修復とHill-Sachs損傷部への腱板縫合を行った．術後3年，JOAスコア92点で，再脱臼は認めていない．鏡視下手術は高齢者の重度不安定肩に対し有効な手術法であると思われた．

　A 67-year-old right-handed male dislocated his right shoulder in a fall from a stepladder, after which he was unable to move the shoulder for fear of dislocating it again.　A bony Bankart lesion (20% defect of the longitudinal diameter of the glenoid) and large Hill-Sachs defect (over the top of the humeral head) were observed on radiographs, and a massive rotator cuff tear was revealed by MRI.　We repaired the bony Bankart lesion and rotator cuff Hill-Sachs lesion area arthroscopically.　As of 36 months after surgery there had been no recurrences of the shoulder dislocation, and the JOA score was 92 points.　Our surgical procedures consisting of repair of the bony Bankart lesion and rotator cuff in the Hill-Sachs lesion area were effective in treating the traumatic severe anterior instability of the shoulder in this elderly patient.