Capsular Shifting Procedure with Cruciate Repair for Recurrent Anterior Shoulder Dislocation - A Preliminary Report

以關節囊轉移及十字縫合治療復發性肩關節前方脫臼－初步報告

許弘昌(Horng-Chaung Hsu) ； 吳濬哲(Jiunn-Jer Wu) ； 林禮文(Levin Lin) ； 張政彥(Cheng-Yen Chang) ； 楊大中(Dah-Jung Yang)

《Journal of Orthopaedic Surgery Taiwan》 4卷4期 (1987/12) Pp. 207-215

摘要

因肩關節盂較淺使得肩關節先天上就較不穩定，而肩關節盂緣使得肩關節盂相對地變深並且增加了肱骨頭與肩關節盂接觸的表面積。在復發性肩關節前方脫臼病人常可發現其關節盂緣受傷、關節鬆弛及邦卡氏病害。從75年4月至76年元月，我們術前使用雙重對比肩關節電腦斷層攝影檢查10位復發性肩關節前方脫臼的病人然後做手術對照。術中發現主要的病變包括關節鬆弛，盂緣變鈍、變薄、弔桶型撕裂（3位）甚或消失（3位），邦下氏病害在前上方（4位）或前下方（6位）包關節囊從關節盂撕裂（9位）及關節盂骨折（1位）。
據文獻記載，復發性肩關節前方脫臼重建術很多，我們依據Near在1980年提出的關節囊轉移的觀念也是一種邦卡氏重建術修飾成十字縫合，我們就其合理的理論根據及治療上的優點提出討論。

並列摘要

The shallowness of the glenoid fossa makes the shoulder inherently unstable. The glenoid labrum serves to deepen the shallow cup of the bony glenoid and increases the contact area between the glenoid and humeral head. An injured labrum, a lax or ballooned capsule and Bankart lesion were the frequent surgical findings in recurrent anterior shoulder dislocation. From April, 1986 to January, 1987, we used double contrast CT arthro-graphy for 10 patients with recurrent anterior shoulder dislocation a detect and correlate the surgical lesions accurately. The main pathological findings were capsular laxity and redundancy, various types of labrum injury including blunting, attenuation, Bucket-handle tear (n=3) or even loss of the anterior labrum (n=3). Bankart lesion in anterosuperior (n=4) or anteroinferior (n=6) portion including stripping, stretching of the capsule (n=9) or even avulsion fracture of the glenoid (n=1) were found.
There were many kinds of reconstruction method for the recurrent anterior shoulder dislocation in the literature, we reconstructed the lesions with a modified Bankart procedure based on the concept of capsular shift of Neer in 1980. The logical rationale and merits of the treatment will be presented and discussed.

並列關鍵字

recurrent anterior shoulder dislocation ； capsular shift ； cruciate repair