S. GUMINA, F. POSTACCHINI
J Bone Joint Surg [Br] 1997;79-B:540-3.
Of 545 consecutive patients with anterior
shoulder dislocations, 108 (20%) were aged 60 years or more at the time of
injury. We reviewed and radiographed 95 of these elderly patients after a mean
follow-up of 7.1 years. Axillary nerve injuries were seen in 9.3% of the 108
patients, but all recovered completely in 3 to 12 months. There were single or
multiple recurrences of dislocation in 21 patients (22.1%), but within this
group age had no influence on the tendency to redislocate.
Tears of the rotator-cuff were diagnosed by
imaging studies or clinically in 58 patients (61%), including all who had
redislocations. Sixteen patients required surgery. Eight with a single
dislocation and a cuff tear had only repair of the torn cuff. Of the eight
patients with multiple dislocations requiring operation, five also had a torn
cuff and needed either a stabilising procedure and a cuff repair or repair of
the cuff only. All patients who were operated on had a satisfactory result,
with the exception of those with multiple redislocations and a cuff tear who
had repair of the cuff only.
Anterior shoulder dislocation in elderly
subjects is more common than is generally believed; 20% suffer redislocation
and 60% have a cuff tear. Operation may be needed to repair a torn cuff or to
stabilise the shoulder. Patients with multiple redislocations will probably
require both procedures.
545人の肩関節前脱臼のうち108人（20％）が60歳以上であった。そのうち95人を平均7.1年間にわたって経過観察した。
腋窩神経障害が9.3％に見られたが3ヶ月から12ヶ月で完全に消失した。
108人のうち58人（61％）に臨床所見と画像所見から腱板断裂が認められた。
16人は再脱臼をして手術が必要。
そのうち8人は1回の脱臼で腱板修復術のみを施行。5人は腱板修復術と関節制動術が必要であった。残りの3人は腱板断裂が認められず関節制動術のみ施行。
理学療法を行う上で必要な事は如何に肩関節を安定化させるべきかということ。
関節構成体が安定するまでの6週間は外転や外旋可動域の拡大には注意を要する。
但し、過度な肩峰下組織の癒着は夜間痛の出現にも繋がる。必要な関節の安定化と不要な拘縮予防という観点が重要だ。
