Abstract des Autors

Bei Schulterinstabilitaeten kommt der befundorientierten Behandlung eine herausragende prognostische Bedeutung fuer den Funktionserhalt des Gelenkes zu. Zur Diagnostik ist das Doppelkontrast-Arthro-CT indiziert bei rezidivierenden, posttraumatischen wie habituellen Luxationen, Subluxationen sowie beim postoperativen Rezidiv. Neben der Darstellung skelettaerer Veraenderungen (Hill-Sachs-Delle, Bankart-Defekt) bietet das Arthro-CT die Moeglichkeit zur Beurteilung der Gelenkkapsel sowie des Labrum glenoidale. Zwischen 11/90 und 9/93 haben wir 38 Doppelkontrast-Arthro-CTs bei rezidivierender Schulterinstabilitaet durchgefuehrt. Untersucht wurden 35 Maenner und drei Frauen. Bei 24 Patienten wurde eine offene schulterstabilisierende Operation durchgefuehrt und die Befunde mit denen im Arthro-CT verglichen. Von 9 intraoperativ verifizierten Labrumdissektionen wurden 8 im CT richtig beurteilt. Von 9 intraoperativ diagnostizierten Labrumabrissen wurden 6 im Arthro-CT gesehen, drei als Dissektion beschrieben. Alle subperiostalen Kapselabloesungen und knoechernen Bankart-Defekte wurden uebereinstimmend im Arthro-CT und intraoperativ verifiziert. Die Doppelkontrast-Arthro-Computertomographie deckt semiinvasiv und komplikationsarm knoecherne wie weichteilbedingte Luxationsfaktoren im Schultergelenk auf. Verf.-Referat

Abstract des Autors

Timeless and lesion-related treatment are important in the different shoulder instabilities in order to get a good functional result. Within the step-by-step programme of diagnostic possibilities the double contrast computerized arthrotomography is particularly indicated in recurrent posttraumatic and habitual dislocations, in subluxations as well as for clarification of causes of postoperative recurrence. Besides the documentation of skeletal changes (Hill-Sachs-lesion, Bankart defect), double-contrast arthro-CT offers the possibility to identify detachments of the joint capsule or labral tears. Between 11/90 and 9/93 we performed 38 double contrast arthro-CTs for recurrent shoulder instabilities. 35 men and 3 women were examined. The mean age of the sportive patients were 29 years. Preoperatively we diagnosed in 21 cases a recurrent posttraumatic, in 7cases a habitual shoulder instability. Apart from one multidirectional and three posterior instabilities we found two cases of subluxation. In the mean-time 24 patients were treated with an open stabilizing operation of the shoulder. The operative findings were compared with the results of double contrast arthro-CT. In a total of 38 performed arthro-CTs we found labral tears in 4 cases, 14 labral dissections, and 10 times a complete labral discontinuity. 8 of 9 labrum dissections found intraoperatively were correctly identified on CT. One dissection was not even seen retrospectively on arthro-CT. Six of nine complete labrum discontinuities were seen on arthro-CT, three described as a dissection. All capsular detachments and bony Bankart lesions found on CT were confirmed intraoperatively. The double contrast arthro-CT offers the possibility of identifying bony and soft tissue-related causes for shoulder dislocation being a semi-invasive procedure, technically easy to perform and having a low complication rate. Decisions whether to treat conservatively or to proceed toward refixation of detached anterior capsule labrum complex or to bring in a cortico-cancellous bone block onto the scapular neck can already be taken preoperatively and on an outpatient basis.