臨床整形外科58巻10号

2023年10月発行

特集 腱板断裂の治療戦略 一次修復不能腱板断裂に対する治療

鏡視下肩上方関節包再建術におけるグラフトマネジメント—コツとピットフォール

著者： 長谷川彰彦¹ 三幡輝久¹

所属機関： ¹大阪医科薬科大学整形外科学教室

ページ範囲：P.1223 - P.1231

鏡視下肩上方関節包再建術は，一次修復困難な腱板断裂に対してMihataが考案した関節温存手術である．本術式ではグラフトの治癒が治療成績に影響を及ぼすため，肩関節鏡手技のみならず，大腿筋膜グラフトのマネジメントが治療成績に大きく影響する．本稿では，鏡視下肩上方関節包再建術のための大腿筋膜グラフト作成から肩峰下腔へのグラフト挿入と固定に至るまで，筆者らの手術法を紹介しながら，本術式のコツとピットフォールについて述べる．

参考文献

1) Mihata T, McGarry MH, Pirolo JM, et al. Superior capsule reconstruction to restore superior stability in irreparable rotator cuff tears:a biomechanical cadaveric study. Am J Sports Med 2012;40(10):2248-55.

2) Mihata T, Lee TQ, Watanabe C, et al. Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthroscopy 2013;29(3):459-70.

3) Mihata T, Lee TQ, Hasegawa A, et al. Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears. Am J Sports Med 2018;46(11):2707-16.

4) Hasegawa A, Mihata T, Fukunishi K, et al. Structural and clinical outcomes after superior capsule reconstruction using an at least 6-mm-thick fascia lata autograft including the intermuscular septum. J Shoulder Elbow Surg 2023;32(2):e48-59. doi:10.1016/j.jse.2022.07.010.

5) Hasegawa A, Mihata T, Yamamoto N, et al. Postoperative graft integrity affects clinical outcomes after superior capsule reconstruction using fascia lata autograft in posterior-superior rotator cuff tears:a multicenter study. J Shoulder Elbow Surg 2023;32(7):1476-85.

6) Mihata T, Lee TQ, Fukunishi K, et al. Return to sports and physical work after arthroscopic superior capsule reconstruction among patients with irreparable rotator cuff tears. Am J Sports Med 2018;46(5):1077-83.

7) Mihata T, Lee TQ, Hasegawa A, et al. Arthroscopic superior capsule reconstruction for irreparable rotator cuff tears:comparison of clinical outcomes with and without subscapularis tear. Am J Sports Med 2020;48(14):3429-38.

8) Mihata T, McGarry MH, Kahn T, et al. Biomechanical effects of acromioplasty on superior capsule reconstruction for irreparable supraspinatus tendon tears. Am J Sports Med 2016;44(1):191-7.

9) Hasegawa A, Mihata T, Itami Y, et al. Histologic changes during healing with autologous fascia lata graft after superior capsule reconstruction in rabbit model. J Shoulder Elbow Surg 2021;30(10):2247-59.

10) 長谷川彰彦，三幡輝久，河上　剛，他．肩上方関節包再建術における大腿筋膜採取が股関節に与える影響．肩関節2020；44(1)：108-11．

11) Mihata T, McGarry MH, Kahn T, et al. Biomechanical effect of thickness and tension of fascia lata graft on glenohumeral stability for superior capsule reconstruction in irreparable supraspinatus tears. Arthroscopy 2016;32(3):418-26.

12) Mihata T, McGarry MH, Kahn T, et al. Biomechanical role of capsular continuity in superior capsule reconstruction for irreparable tears of the supraspinatus tendon. Am J Sports Med 2016;44(6):1423-30.