Hill-Sachs损伤伴肩关节前方不稳的镜下手术治疗  

Arthroscopic operation for treatment of recurrent traumatic anterior shoulder instability accompanied with Hill-Sachs lesion

作　　者：傅仰攀[1] 黄长明[1] 范华强[1] 张少战[1] 王建雄[1] 卢海燕[1] 唐聪[1] 甘志勇[1] 李宏达[1] FU Yang-pan HUANG Chang-ming FAN Hua-qiang et al(Department of Orthopedics, Chenggong Hos- pital of Xiamen University, Xiamen 361003, China)

机构地区：[1]厦门大学附属成功医院骨科解放军第174医院骨科,福建厦门361003

出　　处：《中国矫形外科杂志》2017年第16期1468-1472,共5页Orthopedic Journal of China

摘　　要：[目的]探讨关节镜下盂唇修补联合Remplissage技术治疗伴有Hill-Sachs缺损的肩关节前方不稳的临床效果。[方法]2012年2月~2015年2月,60例复发性肩关节前方不稳接受关节镜下盂唇修补联合Remplissage手术治疗,其中男50例,女10例。手术时平均年龄29.30岁(21.50~45.80岁)。所有病例术前均证实存在前方盂唇损伤和明显的Hill-Sachs损伤,所有患者均由同一名医生施行关节镜下手术。[结果]术前肩关节不稳ISIS评分(3.80±0.70)分。平均随访时间16.6个月(12~23个月)。所有患者术后肩关节前屈上举、内旋及体侧外旋活动度与术前无明显差异。ASES评分由术前的(85.23±13.45)分增加至末次随访时的(94.11±8.16)分,差异具有统计学意义(P<0.01)。Constant-Murley评分由术前的(95.92±3.41)分增加至末次随访时的(98.94±2.40)分,两时间点差异具有统计学意义(P<0.01);Rowe评分由术前的(42.12±4.92)分增加至末次随访时的(88.11±3.55)分,差异具有统计学意义(P<0.01)。末次随访未发现有再次肩关节脱位者。[结论]关节镜下前方关节囊修补联合Remplissage手术治疗合并Hill-Sachs缺损的临床效果满意,能够有效重建肩关节功能,避免术后再脱位的发生。[Objective] To investigate clinical results of arthroscopic labrum repair combined with Remplissage proce- dure in treating recurrent traumatic anterior shoulder instability accompanied with Hill-Sachs lesion. ~Methods] Between February 2012 and February 2015, 60 patients who suffered from recurrent traumatic anterior shoulder instability accompa- nied with Hill-Sachs lesion were treated with all arthroscopic labrum repair combined with Remplissage procedure. Among them, 50 patients were male and 10 patients were female, with an average age of 29.31 years （21 - 46 years） at the surgery. Anterior labrum tears and Hill-Sachs lesion were confirmed before surgery by MRI and 3 dimensional CT in all patients. IRe- suits] The preoperative Instability Severity Index Score （ISIS） was （3.80±0.70） in average.No significant changes were found regarding range of motion, including active forward elevation, external and internal rotation after the surgery. The pa- tients were followed for an average of 16. 6 months （12±23 months） .The American Shoulder and Elbow Society （ASES）scores increased significantly from （85.00±13.00） preoper- atively to （94.00± 8.00） at the latest follow-tip （P〈 0.01） , additionally, the Constant-Murley scores in- creased significantly from （95.90±3.40） to （98.90±2.40） （P〈0.OI） , moreover, the Rowe scores increased signifi-cantly from （42.10＋_4.90） to （88.10±3.50） （P〈0.01） as well. During the follow-up period, no recurrent dislocation oc- curred in any patient. [Conclusion] Arthroscopic lahrum repair comhined with Remplissage procedure does achieve satisfac- tory clinical results in term of shoulder function for treatment ofrecurrent traumatic anterior shoulder instability aceompanied with Hill-Sachs lesion, with a lower recurrence rate.

关 键 词：肩关节不稳 Hill-Sachs损伤 关节镜 盂唇修补 Remplissage技术 

分 类 号：R687.4[医药卫生—骨科学]