改良关节镜下喙突移位Latarjet手术治疗肩关节前方不稳定  

Modified arthroscopic Latarjet procedure for the treatment of anterior shoulder instability

作　　者：吴关[1] 姜春岩[1] 鲁谊[1] 朱以明[1] 李奉龙[1] 李旭[1] 

机构地区：[1]北京积水潭医院运动损伤科,北京100035

出　　处：《北京大学学报（医学版）》2015年第2期321-325,共5页Journal of Peking University:Health Sciences

基　　金：北京市科学技术委员会课题(Z141107002514001);北京市自然科学基金项目(7142074)资助~~

摘　　要：目的:探讨改良关节镜下喙突移位Latarjet手术的技术特点及手术效果。方法:关节镜下Latarjet手术是治疗复杂肩关节前方不稳定的有效方法,而经典的关节镜下Latarjet手术没有进行前方关节囊的重建,且术中对肩胛下肌破坏较明显。从2013年2月开始,北京积水潭医院运动损伤科对经典关节镜下Latarjet手术进行改良,术中加入前方关节囊重建术,并采取经腱腹结合部位分离肩胛下肌的技术充分保护肩胛下肌,术后第2天行CT检查评价骨移植物位置。结果:2013年2月至2014年8月,共有51例肩关节前向不稳定患者行改良后的关节镜下Latarjet手术,所有患者手术均顺利完成,术后CT显示,骨块与肩盂平齐的病例为48例(94.1%),偏内侧病例3例(5.9%)。骨块位于2点至5点位置的病例49例占96.0%,高于2点位置1例占2.0%,低于5点位置1例占2.0%。术后随访未发现复发脱位及半脱位。结论:改良关节镜下Latarjet手术不仅可按照经典切开术式进行操作,同时又能兼具关节镜下手术的微创、精细等优势,喙突骨块可达到良好的位置,手术结果满意。Objective：To present the surgical technique and to evaluate the results of the modified ar-throscopic Latarjet procedure.Methods： Arthroscopic Latarjet procedure has proven to be a reliable method of treatment for difficult anteroinferior instability of the shoulder joint.However, there is no ante-rior capsule reattachment and too much subscapularis damage for the classic procedure.From February 2013 , we modified the classic procedure with reattachment of anterior joint capsule and muscle-tendon junction splitting of subscapularis.Coracoid graft position was evaluated using CT scanning.Results：From March 2012 to August 2014, 51 modified Latarjet procedures were successfully performed arthro-scopically for patients with anterior shoulder instability.According to the CT scanning at the final follow up, the graft was flush with the glenoid in 94.1%, and medially placed in 5.9%.Vertical positioning was perfect in 96.0%（2 to 5 o’clock）, too high in 2.0%, and too low in 2.0%.There were no cases of recurrent dislocation or subluxation.Conclusion： The modified arthroscopic Latarjet procedure has shown satisfactory results with good graft positioning.It is a minimal invasive and accurate approach, which combines the advantages of the open procedure.

关 键 词：肩关节 关节不稳定性 关节镜检查 

分 类 号：R684.7[医药卫生—骨科学]