Sprengel shoulderに対する肩甲骨骨切り術の手術成績

Clinical Results of the Scapular Osteotomy for Sprengel's Shoulder

　抄録：Sprengel変形に対するWilkinson法の手術成績についてretrospectiveに調査を行った．対象は，5例6肩，手術時年齢は平均6.6歳，術後経過観察期間は，平均4.8年である．術式はWilkinsonらの報告に従って肩甲骨の骨切り術を行った．調査項目は，手術時間，出血量，術前後における肩甲骨高位のX線学的評価，関節可動域等である．手術時間は平均2時間00分，術中出血量は平均108mlであった．肩甲骨高位は改善はみられたが，なお残存していた．関節可動域は側方挙上が術前平均95°，術後平均151°と全例で改善がみられた．Wilkinson法は，骨切りを伴うことから侵襲の大きい手術と考えられがちだが，簡便かつ安全な術式であり，特に機能回復に優れていた．しかし骨切りによる引き下げ幅に見合うだけの肩甲骨高位の改善はなく，さらなる改良の余地を残していた．

　We retrospectively assessed the results of Wilkinson's scapular osteotomy for Sprengel's shoulder. The subjects were 4 females and 1 male, and their mean age at the time of the operation was 6.6 years (range：4-11.2). The mean follow-up period was 4.8 years (range：0.9-14.8). Operation time, blood loss, scapular height on radiographs before and after the operation, range of motion of the shoulders, patient satisfaction, and intra-and post-operative complications were reviewed. Mean operation time was 120 minutes (range：87-170). Mean blood loss was 107.7ml (range：48-293). The mean decrease in scapular height on the postoperative radiographs was 0.7cm. Range of motion of the shoulders improved in every case, and no complications were observed. All of the patients were satisfied with the procedure. In conclusion, although Wilkinson's scapular osteotomy did not completely resolve the shoulder deformity and dysfunction, it was a safe and reliable method.