关节镜下关节囊修补术治疗复发性肩关节前脱位合并HAGL损伤的临床疗效  

Clinical Follow-up after Humeral Avulsion of Glenohumeral Ligament Repair in Patients with Recurrent Anterior Shoulder Instability

作　　者：张海龙[1] 朱以明[1] 鲁谊[1] 李奉龙[1] 姜春岩[1] Zhang Hailong;Zhu Yiming;Lu Yi;Li Fenglong;Jiang Chunyan(Department of Sports Medicine,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院运动医学科,北京100035

出　　处：《中国运动医学杂志》2018年第12期1000-1004,共5页Chinese Journal of Sports Medicine

摘　　要：目的:探讨关节镜下关节囊修补术对复发性肩关节前脱位合并盂肱关节下韧带自肱骨附着点的撕脱(humeral avulsion of glenohumeral ligament,HAGL)损伤的临床疗效。方法:应用关节镜下关节囊修补术治疗合并HAGL损伤的复发性肩关节前脱位患者9例,平均随访时间24.2个月。分别于术前、术后对患者进行体格检查,并采用美国肩肘外科协会评分(American Shoulder&Elbow Surgeons’score,ASES)、Constant-Murley评分和Rowe评分以及是否存在术后再脱位或残存恐惧试验阳性来评价肩关节功能。结果:我院复发性肩关节前脱位患者中HAGL损伤的发病率为0.8%。合并HAGL损伤的复发性肩关节前脱位患者术前患肢主动前屈146.1±43.3°,体侧外旋53.9±8.6°,内旋达到T12(T7～LS);肩关节ASES评分76.8±21.9,Constant-Murley评分81.2±15.8,Rowe评分39.4±6.3。末次随访时,无患者出现肩关节复发脱位,恐惧试验皆为阴性;肩关节主动前屈163.2±13.2°,体侧外旋58.9±3.3°,内旋达T12(T7～L3),与术前相比差异均无统计学意义(P=0.068,P=0.157,P=0.180);ASES评分91.4±7.4,Constant-Murley评分91.6±7.5,Rowe评分94.4±8.1,均较术前显著改善(P<0.05)。结论:HAGL损伤是复发性肩关节前脱位患者中较为罕见的损伤类型。关节镜下关节囊修补术治疗合并HAGL损伤的复发性肩关节前脱位患者可取得满意的临床疗效。Objective To explore the clinical outcome of the arthroscopic humeral avulsion of glenohumeral lig-ament(HAGL) repair in patients suffering from anterior shoulder instability associated with HAGL lesion.Methods A total of 9 patients with anterior shoulder instability and HAGL lesion undergoing the arthroscopic humer-al avulsion were followed up for a mean of 24.2 months.Before the operation and at the final follow-up,theywere given physical examination and evaluated the function of shoulders using the American Shoulder & ElbowSurgeons' score(ASES), Constant-Murley score and Rowe score.Results For patients with recurrent anteriorshoulder instability,the incidence of HAGL lesion was 0.8%.For the 9 patients,no significant difference wasobserved in the range of motion of the affected shoulder before the operation and at the final follow-up withthe initiative anteflexion angle of 146.1±43.3°and 163.2±13.2°,the lateral extorsion angle of 53.9±8.6°and 58.9±3.3°and internal rotation to T12(T7~LS) and T12(T7~L3).No recurrent anterior shoulder instabil-ity occurred during the last follow-up.However, significant improvement was observed in the average ASESscore,Constant-Murley score and Rowe score from 76.8±21.9,81.2±15.8 and 39.4±6.3 to 91.4±7.4,91.6±7.5,and 94.4±8.1 respectively(P<0.05).Conclusion HAGL lesion is rare in patients with the anterior shoulder instability,of a 0.8% occurrence rate in our study.Arthroscopic HAGL repair is an effective techniquefor the treatment of anterior shoulder instability with HAGL lesion.

关 键 词：复发性肩关节前脱位 HAGL损伤 关节镜 

分 类 号：R687.4[医药卫生—骨科学]