关节镜下盂唇修补合并改良Remplissage术治疗伴Hill-Sachs损伤肩关节前方不稳的临床对照研究  

Arthroscopy Combined with Modified Remplissage Procedure for Treating Recurrent Traumatic Anterior Shoulder Instability with Hill-Sachs Lesion

作　　者：肖鸿鹄[1,2] 陈世益[1,2] 陈疾忤[1,2] 华英汇[1,2] 李云霞[1,2] 

机构地区：[1]复旦大学运动医学中心 [2]复旦大学附属华山医院运动医学科ISAKOS关节镜与运动创伤教育培训中心,上海200040

出　　处：《中国运动医学杂志》2012年第5期379-385,共7页Chinese Journal of Sports Medicine

摘　　要：目的:研究盂唇修补合并改良Remplissage手术治疗伴肱骨头中小型Hill-Sachs骨性缺损的创伤性复发性肩关节前方不稳的疗效。方法:选取2006年至2010年经影像学检查确诊为伴肱骨头中小型Hill-Sachs损伤的创伤性复发性肩关节前方不稳患者共42例行回顾性随访研究。所有患者均由同一名医生施行关节镜下前方稳定术。根据是否加用改良Remplissage术式分为A、B两组。A组26例,在2006年至2009年行关节镜下单纯盂唇修补术。B组16例,在2009年至2010年行关节镜下盂唇修补术加改良Remplissage术,采用双线锚钉将后方关节囊(非冈下肌腱)填充于肱骨头缺损处。两组患者术后采用相同方法进行康复训练。采用牛津肩关节不稳评分(OSIS)和ROWE评分进行疗效评估、对比术前和术后3个月、6个月、9个月及12个月时肩关节活动度。结果:所有患者均获得随访,A组随访平均(28.0±5.6)个月(20～38个月);术前、术后OSIS评分分别为(37.0±4.2)分(27～43分)和(18.0±3.3)分(12～25分),ROWE评分分别为(20.2±12.2)分(5～40分)和(83.8±7.3)分(70～95分);术后再脱位患者1例,由再次创伤造成,半脱位患者5例。B组随访平均(19.6±3.8)个月(14～27个月);术前、术后OSIS评分分别为(37.9±4.9)分(29～44分)和(13.4±2.1)分(12～20分),ROWE评分分别为(18.4±8.3)分(5～30分)和(95.3±5.3)分(80～100分);术后无再脱位患者。对两组患者术后肩关节活动度分别测量的结果显示,两组患者术后中立位外旋活动度恢复趋势无明显差异。Kaplan-Meier生存分析显示,两组患者术后不稳复发率差异有统计学意义(P=0.043)。结论:关节镜下盂唇修补合并改良Remplissage手术是治疗伴肱骨头中小型Hill-Sachs损伤的创伤性复发性肩关节前方不稳的有效方法,可显著提高肩关节稳定性,并对术后肩关节活动度无明显影响。Objective To determine if arthroscopic labrum repair plus modified Remplissage proce- dure in treating recurrent traumatic anterior shoulder instability accompanied with mild to moderate Hill- Sachs lesion has better clinical outcome than the arthroscopic labrum repair only. Methods Forty two patients who underwent arthroscopic anterior shoulder stabilization by a same orthopedist from 2006 to 2010 were retrospectively analyzed. They were divided into two groups based on with or without applying modified Remplissage procedure. Group A included 26 patients treating with arthroscopic labrum repair only（from 2006 to 2009） and group B included 16 patients treating with combined modified Remplissage procedure and arthroscopic labrum repair （from 2009 to 2010）. The Oxford Shoulder Instability Ques- tionnaire （OSIS） and Rowe＇s score were recorded preoperatively and postoperatively. The ROM was compared before and 3,6,9 and 12 months after operations. Results Patients in group A were followed up for an average of 28.0＋5.6 months（20-38 months）. Their OSIS scores were 37.0±4.2 points（27-43） and 18.0±3.3 points（12-25） and their Rowe＇s scores were 20.2±12.2 points（5-40） and 83.8±7.3 points （70-95） before and after operation. One re-dislocation occurred due to injury,and five subluxations were noticed in group A. Patients in group B were followed up for an average of 19.6±3.8 month （14-27 months）. Their OSIS scores were 37.9±4.9 points（29-44） and 13.4±2.1 points（12-20）, and their Rowe＇ s scores were 18.4±8.3 points （5-30） and 95.3±5.3 points （80-100） before and after operation. No re- dislocation or subluxation occurred in group B. The range of external rotation showed no difference between the two groups. Kaplan-Meier analysis showed that there were significant differences in the recur- rence rate of instability between the two groups. Conclusion Arthroscopic modified Remplissage procedure is effective for treating recurrent traumatic anterior shoulder inst

关 键 词：Hill—Sachs损伤 改良Remplissage术 肩关节前方不稳 

分 类 号：R687.4[医药卫生—骨科学]