关节镜下非打结型与打结型缝合锚钉Bankart重建治疗复发性肩关节前向不稳  

Arthroscopic Bankart repair for recurrent anterior shoulder instability with bioknotless or knot suture anchors

作　　者：郑小飞[1] 黄华扬[1] 张余[1] 李凭跃[1] 

机构地区：[1]广州军区广州总医院骨病关节科,510010

出　　处：《中国骨科临床与基础研究杂志》2012年第2期90-96,共7页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：广东省科技计划攻关项目(2010B031100016)

摘　　要：目的探讨关节镜下非打结型与打结型缝合锚钉对复发性肩关节前向不稳Bankart损伤的临床效果。方法回顾性分析2006年3月至2009年1月广州军区广州总医院收治的44例复发性肩关节脱位Bankart损伤患者的临床资料,根据关节镜下修复方式的不同分为非打结组(可吸收非打结型缝合锚钉修复,20例)和打结组(打结型缝合锚钉修复,24例)。采用美国肩肘外科医师(ASES)评分及Constant-Murley功能评分对患者术前、末次随访时肩关节功能进行评估,记录肩关节活动范围,观察并发症发生情况。结果所有患者获得随访,随访时间20～46个月,平均随访时间30个月。非打结组术前和终末随访时肩关节前屈上举角度、外展90°时外旋角度分别为(163±9)°和(170±4)°、(58±14)°和(90±6)°,术后外展90°时患侧外旋角度较健侧受限(8±6)°;术前和终末随访时ASES评分、Constant-Murley评分分别为(77.4±3.7)分和(94.3±2.6)分、(78.1±4.6)分和(93.9±3.7)分,两者比较,差异有统计学意义(P<0.05)。打结组术前和终末随访时肩关节前屈上举角度、外展90°时外旋角度分别为(162±8)°和(170±6)°、(61±13)°和(91±6)°,术后外展90°时患侧外旋角度较健侧受限(5±3)°;术前和终末随访时ASES评分、Constant-Murley评分分别为(75.8±2.9)分和(95.1±3.7)分、(76.2±5.9)分和(92.8±5.2)分,两者比较,差异有统计学意义(P<0.05)。两组间术前、术后各项指标比较,差异无统计学意义(P>0.05)。患者均未出现术后再脱位,均重返伤前工作岗位。结论肩关节镜下Bankart重建手术是治疗复发性肩关节前向不稳的有效方法,非打结型和打结型缝合锚钉修复Bankart损伤疗效相似。Objective To explore the clinical results of arthroscopic Bankart repair for the treatment of recurrent anterior shoulder instability with bioknotless or knot suture anchors. Methods From March 2006 to January 2009, 44 patients of recurrent anterior shoulder instability were treated by arthroscopic Bankart injury repair with bioknotless or knot suture anchors at Guangzhou General Hospital of Guangzhou Military Command. Among them, 20 patients were treated with bioknotless suture anchors （bioknotless group）, and 24 were treated with knot suture anchors （bioknot group）. Shoulder joint functions were assessed by American Shoulder and Elbow Surgeons （ASES） and Constant-Murley scores evaluated at preoperation and the last follow-up. Shoulder range of motion was recorded. Postoperative complications were observed. Results All patients were followed up for an average time of 30 months （range, 20-46 months）. In bioknotless group, the mean forward flexion was （163 ± 9）° and （170 ± 4）° preand post-operatively; the mean external rotation in 90° abduction was （58 ± 14）° and （90 ± 6）° preand post-operatively, which was less （8 ± 6）° than that of normal side postoperatively; the preand post-operative ASES score was （78.1 ± 4.6） and （93.9 ± 3.7） and the preand post-operative Constant-Murley score was （77.4 ± 3.7） and （94.3 ± 2.6）. In bioknot group, the mean forward flexion was （162 ± 8）° and （170 ± 6）° preand post-operatively; The mean external rotation in 90° abduction was （61 ± 13）° and （91 ± 6）° preand post-operatively, which was less （5 ± 3）° than that of normal side shoulder postoperatively; the preand post-operative ASES score was （75.8 ± 2.9） and （95.1 ± 3.7）; and the preand post-operative Constant-Murley score was （76.2 ± 5.9） and （92.8 ± 5.2）. In every group, all above data had significant differences between preoperation and the last follow-up （P 〈0.05）, but when compared those at preoperation an

关 键 词：肩脱位 BANKART损伤 关节镜检查 缝合锚钉 

分 类 号：R687.3[医药卫生—骨科学]