复发性肩关节前脱位与关节内继发损伤的相关性研究  

CORRELATION ANALYSIS BETWEEN RECURRENT ANTERIOR SHOULDER DISLOCATION AND SECONDARY INTRA-ARTICULAR INJURIES

作　　者：李海峰[1] 刘玉杰[1] 李众利[1] 李春宝[1] 董晓艳[1] 朱娟丽[1] 刘洋[1] 

机构地区：[1]解放军总医院骨科,北京100853

出　　处：《中国修复重建外科杂志》2012年第3期308-312,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的通过分析肩关节前脱位次数、病程与关节内继发损伤的关系,探讨复发性肩关节前脱位对关节内继发损伤的影响。方法回顾分析2005年1月-2009年6月关节镜下应用缝合锚钉行Bankart重建术治疗的59例复发性肩关节前脱位患者临床资料。男48例,女11例;年龄15～42岁,平均27.6岁。初次脱位原因:接触性体育运动21例,非接触性体育运动13例,日常活动11例,外伤14例。术前脱位3～32次,平均10.6次。初次脱位至手术时间为11个月～12年,中位时间5.9年。患者恐惧试验及复位试验均呈阳性。术前美国加州大学洛杉矶分校(UCLA)肩关节功能评分为(22.3±2.4)分,Constant-Murley评分为(73.1±5.8)分。关节镜下观察关节内继发损伤情况,并进行统计分析。结果术后患者切口均Ⅰ期愈合。患者均获随访,随访时间16～58个月,平均37.3个月。末次随访时,UCLA肩关节功能评分为(34.6±1.7)分,Constant-Murley评分为(86.7±6.1)分,与术前比较差异均有统计学意义(P<0.05)。术前关节脱位次数和关节软骨损伤的严重程度成正相关(rs=0.345,P=0.007),和Hill-Sachs损伤严重程度成正相关(rs=0.708,P=0.000);首次脱位至手术时间和关节软骨损伤严重程度成正相关(rs=0.498,P=0.000),与Hill-Sachs损伤严重程度无相关性(rs=0.021,P=0.874)。结论复发性肩关节前脱位早期行Bankart重建有利于肩关节功能恢复,避免或延缓关节内继发损伤的发生和发展。Objective To explore the effect of recurrent anterior shoulder dislocation on the secondary intra-articular injuries through analyzing the correlation between the number of dislocation,disease duration,and the secondary intra-articular injuries.Methods The clinical data were analyzed retrospectively from 59 patients with recurrent anterior shoulder dislocation who underwent arthroscopic Bankart reconstruction using suture anchor between January 2005 and June 2009.There were 48 males and 11 females,and the average age was 27.6 years（range,15-42 years）.The causes of first dislocation included contact sports（21 cases）,non-contact sports（13 cases）,daily activities（11 cases）,and trauma（14 cases）.The average number of preoperative dislocations was 10.6 times（range,3-32 times）.The time between first dislocation and surgery was 11 months to 12 years（median,5.9 years）.The results of apprehension test and relocation test were positive in all patients.The University of California Los Angeles（UCLA） score was 22.3 ± 2.4,and Constant-Murley score was 73.1 ± 5.8 preoperatively.According to the arthroscopic findings,the effect of recurrent anterior shoulder dislocation on the secondary intra-articular injuries was analyzed.Results All incisions healed by first intention,and no early complication occurred.All 59 patients were followed up 37.3 months on average（range,16-58 months）.At last follow-up,UCLA score was 34.6 ± 1.7 and Constant-Murley score was 86.7 ± 6.1,showing significant differences when compared with preoperative scores（P 0.05）.The number of preoperative dislocations was positively correlated with the severity of secondary articular cartilage injury（rs=0.345,P=0.007） and the severity of Hill-Sachs injury（rs=0.708,P=0.000）.The time between first dislocation and surgery had a positive correlation with the severity of secondary articular cartilage injury（rs=0.498,P=0.000）,but it had no correlation with the severity of Hill-Sachs injury（rs=0.021,P=0.874）.Conclus

关 键 词：复发性肩关节前脱位 关节内继发损伤 相关性分析 

分 类 号：R687.4[医药卫生—骨科学]