全镜下Latarjet手术治疗复发性肩关节前脱位伴严重肩盂骨缺损的早中期疗效分析  

Total arthroscopic Latarjet procedure combined with Bankart repair for treatment of anterior shoulder dislocation with severe bipolar bone loss: early and mid-term clinical outcomes

作　　者：赵立连[1] 卢明峰 邢基斯[1] 何利雷[1] 许挺[1] Zhao Lilian;Lu Mingfeng;Xing Jisi;He Lilei;Xu Ting(Department of Orthopaedic Sports Medicine,Foshan Hospital of TCM,Foshan 528000,China)

机构地区：[1]佛山市中医院运动医学科,528000

出　　处：《中华肩肘外科电子杂志》2019年第1期25-34,共10页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：广东省医学科学技术研究院(20161181228306)

摘　　要：目的观察全关节镜下Latarjet手术治疗复发性肩关节前脱位合并严重肩盂骨缺损的早中期疗效。方法对2015年4月至2017年2月在佛山中医院收治的复发性肩关节前脱位合并严重骨缺损行全镜下Latarjet手术患者病例资料进行回顾性研究,随访资料完整的共12例,其中男性10例、女性2例,左侧7例、右侧5例,平均年龄31.89岁(19～69岁),术前前方恐惧试验均为阳性,平均脱位14.5次(9～30次)。所有患者均是根据术前双侧肩关节三维CT扫描对比测量计算其肩盂骨缺损程度>健侧肩盂宽度的25%,术中肩关节镜下对肩盂前缘骨缺损的范围和程度二次评估,所有患者肩盂呈倒梨形,且均合并Off-track Hill-Sachs损伤,所有病例均采用全关节镜下Latarjet术式加Bankart修补术进行重建,随访时采用美国肩肘外科医师评分(American shoulder and elbow surgeons,ASES)、肩关节功能评定法(constant-murley-score,CMS)、Rowe评分、视觉模拟评分法(visual analogue scale,VAS)和关节主动活动度评估术后患者肩关节功能,并且通过术后CT平扫和三维重建评估喙突植骨块的位置和吸收情况。结果所有病例术后平均随访16.6个月(13～24个月),12例患者术后均未出现再脱位,术前与末次随访时前屈上举(142.00±4.88)°和(169.50±5.56)°相比较,差异有统计学意义(t=12.50,P<0.05);术前与末次随访时内旋至T8和T9相比较,差异无统计学意义(t=2.29,P>0.05);术前与末次随访时平均体侧外旋(59.00±4.20)°和(52.57±2.99)°相比较,差异具有统计学意义(t=6.97,P<0.05);术前与末次随访时平均外展90°外旋(87.29±4.72)°和(79.00±7.53)°相比较,差异具有统计学意义(t=6.35,P<0.05);术前与末次随访时ASES评分(69.20±3.42)分和(97.90±3.51)分相比较,差异具有统计学意义(t=779.24,P<0.05);术前与末次随访时ConstantMurley评分(90.86±1.57和(96.57±2.99)分相比较,差异具有统计学意义(t=8.40,P<0.05);术前与末次随访时Rowe�Background Shoulder joint dislocation,also known as glenohumeral joint dislocation,is the most common joint dislocation in clinic,which accounts for about 40% of all joint dislocation.It occurs mostly in young adult with more men being affected than women.Recurrent shoulder dislocation is one type of dislocation of shoulder joint,and there is a higher occurrence of anterior dislocation.This dislocation is mainly due to the anterior capsule tear after initial dislocation,the avulsion of the glenoid or the rim of it,and the malunion caused by un-repaired of them,as well as the posterior humeral fracture of humeral head.Consequently,repeated dislocation can occur.At present,there is no domestic and international consensus in the choice of surgical method for recurrent shoulder dislocation with severe bone defect.Previously,we took lower glenoid bony defect diameter≥25% or deep Hill-sachs defect engaging with the glenoid with 90°of shoulder joint abduction and external rotation as giant bone defect.Some literatures report that arthroscopic Bankart repair surgery has a recurrence rate of up to 67%for these two types of shoulder dislocation combined with giant bone defect.The current treatment mostly uses Latarjet surgery or autogeneic or allogeneic bone grafting.This surgical method can regain the stability of shoulder joint and reduce the rate of redislocation.Methods 1.Normal information:The retrospective study was performed in 12 patients(10 males and 2 females)who underwent Latarjet surgery and Bankart repair for the treatment of recurrent shoulder anterior dislocation with severe bone defect from April 2015 to February 2017,there were 7 cases with the left side affected and 5 cases with the right side affected,and the age ranged from 19-69 years with an average of 31.89 years.The average duration of disease was 25.12 days.The preoperative apprehension test was positive,and the average dislocation time was 14.5(9 to 30 times).As the glenoid was measured before the operation,the degree of bone defect was more th

关 键 词：LATARJET 肩关节 脱位 骨性缺损 

分 类 号：R687.4[医药卫生—骨科学]