胸鎖関節後方脱臼の1例

A Method for Reduction of Posterior Sternoculavicular Dislocation. Case Report

　胸鎖関節後方脱臼の発生頻度は極めて稀である．症状としては胸鎖関節部の腫脹，疼痛，肩関節運動制限などを認めるほか，時に気管・食道・大血管損傷などの重篤な障害が危惧される．症例は16歳の男性で，ラグビー試合中に直達外力で受傷した．初診医では診断に至らず，疼痛が持続するため精査目的に当科を紹介され受診となった．3D-CTで胸鎖関節後方脱臼と診断した．受傷2日目に全身麻酔下に非観血的脱臼整復術を施行した．従来法での整復が困難であったが，肩関節屈曲位での屈曲牽引法で整復し得た．胸鎖関節後方脱臼の整復法を，文献的考察をふまえ検討した．

　Posterior sternoclavicular (SC) dislocation is a rare injury.　The symptoms of posterior SC dislocation include swelling, pain and limitation of shoulder joint movement.　It is also frequently associated with serious and life-threatening injuries involving the trachea, esophagus, or great vessels.　We present the case of a 16-year-old male who sustained the injury from direct force while playing rugby.　The diagnosis was not recognized at his initial presentation at a certain clinic.　As the pain persisted, he was referred to our department for further examination.　A 3D CT examination revealed that he was suffering from a posterior SC dislocation.　Two days after his having sustained the trauma, we performed closed reduction under general anesthesia.　We could not reduce the dislocation using the conventional method.　Then we were able to reduce it with traction on the upper arm with the shoulder flexion maintained at 90 degrees.　In this report, the reduction method we used is discussed and the current literature regarding this subject is also reviewed.