喙突移位阻滞术治疗肩关节复发性前脱位  

Bristow coracoid bone block procedure for treatment of recurrent anterior dislocation of shoulder

作　　者：张伟滨[1] 张治华[2] 王蕾[1] 张海生[1] 陆宸照[1] 

机构地区：[1]上海第二医科大学附属瑞金医院骨科,上海市伤骨科研究所,200025 [2]上海第二医科大学附属新华医院五官科

出　　处：《上海医学》2005年第2期91-95,共5页Shanghai Medical Journal

摘　　要：目的评估Bristow喙突移位阻滞术治疗肩关节复发性前脱位的疗效.方法我院1983年2月～2002年1月采用Bristow喙突移位阻滞术治疗18例肩关节复发性前脱位患者,男12例,女6例,平均随访10.14年(2～21年).18例患者均有肱骨头Hill-sachs病损,其中11例Hill-sachs病损占整个肱骨头体积25%以上.6例患者以往曾接受手术治疗,术后再复发脱位.根据美国肩肘外科医师协会(ASES)评分、康斯坦评分、Duplay评分标准评价该手术前、后患者的肩关节疼痛程度、日常生活动作、肩关节活动度和稳定性以及肩关节周围肌肉肌力和肩胛下肌功能.结果 Bristow术后患侧肩关节功能均较术前明显改善,大多数患者术后疼痛缓解满意,肩关节前举、外展动作不受限,外旋较术前平均损失14.72°,患者能够顺利进行日常生活工作.术后复发不稳定5例,其中1例由再次外伤所致,4例为癫癎患者;螺钉松动、弯曲或断裂6例(33.3%),继发性肩关节骨关节炎1例(5.6%).结论 Bristow喙突移位阻滞术治疗肩关节复发性前脱位的总体疗效满意,但对伴有神经系统疾病和情感性格障碍的患者,术后不稳定的复发率较高,应予慎重考虑.Objective To retrospectively evaluate the result of the Bristow coracoid bone block procedure for the treatment of recurrent anterior dislocation of the shoulder.Methods Between February 1983 and January 2002, we performed the Bristow coracoid bone block procedure to treat eighteen patients including 12 men and 6 women for their recurrent anterior dislocation of the shoulder. The follow-up period ranged from 2 to 21 years, with a mean of 10.14 years. All of them had Hill-sachs lesions, and among them, 11 Hill-sachs lesional area were beyond 25% of volumes of humeral heads.6 patients had either Bankart reconstructive procedures or close reduction and pin fixation once. We used three types of functional assessment systems, which were the American Shoulder and Elbow Surgeons Assessment(ASES), the Constant Score, the Duplay score, to evaluate the pre- and post-operative pain, the daily living activities, the range of motion, stability of the shoulders, strength and function of muscles around the shoulder.Results Most of the patients had satisfactory pain relief and daily living activities postoperatively. The average external rotational limitation measured in the neutral position of the arm was 14.72°.All the patients returned to their posts with original life styles without any trouble of the shoulders. The instability reoccurred in 5 cases, among them, 1 patient had a new injury , the other 4 had epilepsy several episodes postoperatively. Fixed screws were found loosened or broken in 6 cases(33.3%) and secondary osteoarthritis of the shoulder in one.Conclusion The Bristow coracoid bone block procedure is an effective procedure for most patients with complex recurrent anterior dislocation of the shoulder. But we suggest that this procedure should be considered seriously in the patients with central nerve system diseases or with handicapped mood or characters.

关 键 词：治疗 患者 肩关节 脱位 复发性 喙突移位 阻滞 平均 不稳定 体积 

分 类 号：R687[医药卫生—骨科学]