Fall 3.K.SL.9.19.20.21.22.23.24
38 Jahre (männlich)
Krankheitsanamnese:
Vor 4 Jahren erlitt der Patient ein Schultertrauma der rechten Schulter mit folgenden Diagnosen:
Anteroinferiore Luxazion des Schulterkopfes. Bankart. Kontusionsdeformation des Metaepifises des Humers. Subperiostaler anteroinferiore Labrumriß.
Zwei Jahre nach dem Schultertrauma wurde der Patient im Krankenhaus mit folgender Diagnose aufgenommen:
Chronische rezidivierende Instabilität der rechten Schulter als Folge nach der Schulterluxation. Teilruptur Sehne M. Supraspinatus. Hill-Sachs Fraktur. Bankart Fraktur.
Operation am Tag der Aufnahme:
Arthroskopie der rechten Schulter, Stabilisierung der Rotatorenmanschette, Remplissage des Hill-Sachs Defektes mit M. Infraspinatus
Zwei Jahre nach der arthroskopischen Operation an der rechten Schulter wurde der Patient bei uns im WGZM aufgenommen.
Diagnose:
Teilruptur Sehne M. Supraspinatus und Sehne M. Infraspinatus. Knöcherne Veränderungen als Folge nach Fraktur der Tuberkulum Maius, Hill-Sachs Fraktur. Glenoidfraktur mit Dislokation des Knochenfragmentes, Bankart Fraktur. Tendinosis der Sehne M. Subskapularis. Tenosinovialitis der langen Bizepssehne. Sinovitis. Osteoarthrose Grad II. Entzündliche knöcherne Abstossungsveränderungen im Bereich des Ankers nach Remplissage des Hill-Sachses.
Siehe MRT Bildaufnahmen links.
Es wurde im WGZM eine Operation mit der Methode ASGSSG des Systems MIBRAR® durchgeführt.
Operationsergebnis:
3 Monate nach der Operation wurde eine klinische und bildgebende MRT Nachkontrolluntersuchung durchgeführt. Klinisch ist der Patient beschwerdefrei und uneingeschränkt belastungsfähig. Das Schultergelenk hat sich vollkommen stabilisiert. Die MRT Bildaufnahmen zeigen eine vollständige regenerative Rekonstruktion von allen in der Diagnose genannten verletzten Schultergelenkstrukturen. Keine der vorhandenen Pathologien sind mehr festzustellen. Eine vollständige regenerative Rekonstruktion der Sehnen M. Supraspinatus und M. Infraspinatus, Knochen an Stelle des Hill-Sachs Defektes sowie im Bereich des Ankers, Labrum, Reposition des Knochenfragmentes des Glenoides sind zu sehen.
Tendinosis der Sehne M. Subskapularis, Tenosinovialitis der langen Bizepssehne, Sinovitis, sowie Osteoarthrose sind nicht mehr festzustellen.
Siehe MRT Bildaufnahmen rechts.
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