关节镜下后盂唇关节囊折叠缝合治疗肩关节复发性后半脱位  

Arthroscopic treatment of recurrent posterior subluxation of shoulder joint by folding suture the posterior glenoid labial capsule

作　　者：王庆 黄华扬 张涛 区永亮 沈洪园 Wang Qing;Huang Huayang;Zhang Tao;Ou Yongliang;Shen Hongyuan(Department of Orthopaedics,Institute of Traumatic Orthopaedics of PLA,General Hospital of Southern Theater Command of PLA,Guangzhou 510010,China)

机构地区：[1]南部战区总医院骨科医院,全军创伤骨科研究所,广州510010

出　　处：《中华骨科杂志》2020年第16期1047-1053,共7页Chinese Journal of Orthopaedics

基　　金：中国博士后科学基金(2018M643893);广东省科技计划项目(2017B030314139);广州市科技计划项目(201904010315)。

摘　　要：目的探讨关节镜下后盂唇关节囊折叠缝合治疗肩关节复发性后半脱位的近期疗效。方法回顾性分析2015年1月至2018年12月,采用缝合锚技术行关节镜下后盂唇关节囊折叠缝合治疗16例肩关节复发性后半脱位患者资料,男12例,女4例;年龄18~37岁,平均22岁;11例为后盂唇全层撕裂(其中2例合并上盂唇自前向后的撕脱,7例合并后关节囊松弛),5例为后盂唇部分撕裂(均合并后关节囊松弛)。术后肩关节外展30°使用支具固定6周,防止肩关节内旋;术后2~3个月全范围主、被动活动,术后6个月恢复正常运动。使用美国肩肘外科协会(American Society of Shoulder and Elbow Surgery,ASES)评分和加州大学洛杉矶分校(University of California at Los Angeles,UCLA)最终结果评分评价肩关节功能,使用ASES评分中的不稳定评分评价肩关节稳定性。结果16例患者均获得随访,随访时间平均19个月(范围,12~36个月)。ASES肩关节不稳定评分由术前(7.6±1.6)分降低到术后12个月(2.0±1.2)分;ASES评分由术前的(45.9±9.8)分提高到(85.8±6.1)分,其中疼痛评分由术前的(18.9±5.4)分提高到(40.9±4.2)分,生活功能评分由术前的(27.0±7.8)分提高到(44.9±3.4)分;UCLA评分由术前的(16.1±4.5)分提高到(31.9±2.6)分;以上各指标术后与术前比较差异均有统计学意义(t=5.562、39.937、22.063、17.875、15.813,均P<0.001)。术后12个月,1例患者拳击运动时有疼痛,所有患者肩关节无力感及不稳症状明显好转,无一例出现不稳复发;MRI示缝合的后盂唇撕裂愈合。结论关节镜下后盂唇关节囊折叠缝合能修复盂唇损伤、恢复后关节囊紧张,折叠缝合形成的盂唇关节囊复合体增加肩胛盂的后阻挡作用,能够有效治疗肩关节复发性后半脱位,具有良好的近期疗效。Objective To explore the short-term effect of arthroscopic posterior suture of the glenoid labial capsule in the treatment of recurrent posterior subluxation(RPS)of shoulder joint.Methods A retrospective study was conducted on 16 RPS patients who had undergone arthroscopic posterior glenoid capsule folding suture from January 2016 to December 2018,including 12 males and 4 females,with an average age of 22 years(range,18-37 years).11 had full-thickness posterior glenoid tear(2 with SLAP injury,7 with posterior capsular laxity),and 5 had partial posterior glenoid tear(5 with posterior capsular laxity).All 16 patients had active shoulder pain and had undergone arthroscopic posterior glenoid capsule folding suture with suture anchors.After surgery,shoulder abduction was fixed with a sling for 6 weeks to prevent internal rotation of the shoulder;full range of active and passive activities were performed 2-3 months after surgery,and normal movement was resumed 6 months after surgery.Shoulder function was assessed using the American Society of Shoulder and Elbow Surgery(ASES)score and the University of California at Los Angeles(UCLA)end-result score,and shoulder stability was assessed using the instability score in the ASES score.Results All 16 patients were followed up for 19 months(range,12-36 months).The shoulder instability score was reduced from 7.6±1.6 preoperatively to 2.0±1.2 postoperatively(t=5.562,P<0.001);the ASES score was improved from 45.9±9.8 preoperatively to 85.8±6.1(t=39.937,P<0.001);the pain score was increased from 18.9±5.4 preoperatively to 40.9±4.2(t=22.063,P<0.001);the daily life score was improved from 27.0±7.8 preoperatively to 44.9±3.4(t=17.875,P<0.001),and the UCLA score was improved from 16.1±4.5 preoperatively to 31.9±2.6(t=15.813,P<0.001).One patient had pain during boxing 12 months after surgery,and all patients had significant improvement in shoulder weakness and instability.No patient had instability recurrence.Magnetic resonance showed sutured posterior labrum tearhealed.Concl

关 键 词：肩关节 肩脱位 关节镜检查 缝合锚 关节囊 

分 类 号：R687.4[医药卫生—骨科学]