腱板広範囲断裂に対する広背筋移行術の術後成績

Latissimus Dorsi Transfer for Massive Rotator Cuff Tears

　肩関節自動挙上能力が著しく低下し，一次修復が困難な肩腱板広範囲断裂6例6肩に対して広背筋移行術を行い，その治療成績を検討した．術後，肩関節自動屈曲と自動外転，日本整形外科学会肩関節疾患治療判定基準(JOAスコア)，および，visual analog pain scale(VAS)は有意に改善した．広背筋移行術は，一次修復不可能な広範囲腱板断裂の症例に対して，良好な除痛効果と自動可動域の改善が得られる有効な治療手段といえる．しかし，三角筋機能が低下した症例に対しては限界がある．

　We conducted a study to evaluate the outcome of treatment of massive rotator cuff tears with difficulty actively elevating the shoulder by latissimus dorsi (LD) transfer.　Six cases in which a massive rotator cuff tear had been treated by LD transfer were reviewed.　Two years after surgery the results were evaluated based on the active range of motion of the shoulder, the JOA score, and rating on the visual analog pain scale (VAS).　The ranges of active flexion and abduction had increased significantly two years after surgery, and the JOA score and pain level based on the VAS had significantly improved.　LD transfer is an effective procedure for treating massive rotator cuff tears in patients with difficulty actively elevating the shoulder.　However, the presence of deltoid dysfunction sometimes causes a poor outcome after LD transfer.