臨床整形外科51巻8号

2016年08月発行

Lecture

広範囲腱板断裂に対する鏡視下手術の位置づけ

著者： 高橋憲正¹ 菅谷啓之¹

所属機関： ¹船橋整形外科病院肩関節・肘関節センター

ページ範囲：P.720 - P.728

はじめに

　広範囲腱板断裂は，しばしば陳旧性となって有症状となることがあり，その治療の選択に難渋することが少なくない．疼痛や機能改善を目的としてステロイド注射や理学療法がしばしば有効であるが，断裂した腱は修復されないため保存療法では筋力の回復は得られない．したがって機能回復をめざし手術が選択されるが，陳旧性の断裂では，筋の萎縮や脂肪変性が進行し断端の可動性が著しく低下するため，一次修復が困難であったり，修復した腱板に過度な緊張が生じ容易に再断裂を生じうる．2014年4月から本邦にリバース型人工肩関節(以下，RSA)が導入され，70歳以上の偽性麻痺を伴う一次修復困難な広範囲腱板断裂がRSAの適応となった．一方で若年者の断裂では従来どおり鏡視下手術が第一選択となる．本稿では，広範囲腱板断裂の診断と手術適応について述べ，現在の鏡視下手術の位置づけとその実際を紹介する．

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