全关节镜下Latarjet手术治疗肩关节习惯性前脱位合并肩关节盂明显骨缺损  

Total arthroscopic Latarjet procedure for habitual anterior shoulder dislocation and a marked glenoid bone defect

作　　者：黄炎[1] 刘川 陈冬 伍罕 Huang Yan;Liu Chuan;Chen Dong;Wu Han(Department of Sports Medicine,The 7th Center of General Hospital of People's Liberation Army,Beijing 100700,China)

机构地区：[1]解放军总医院第七医学中心,北京100700

出　　处：《中华创伤骨科杂志》2020年第11期967-972,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨全关节镜下Latarjet手术治疗年轻患者肩关节习惯性前脱位合并肩关节盂明显骨缺损的早期疗效。方法回顾性分析2017年1月至2019年6月解放军总医院第七医学中心共收治的37例肩关节习惯性前脱位合并明显骨缺损患者资料。患者均为男性,左侧18例,右侧19例;平均年龄25.4岁(18~36岁)。术前行双侧肩关节三维CT扫描,测量计算患侧肩盂骨缺损面积。所有患者均行全镜下Latarjet手术加关节囊修补。记录并比较术前与末次随访时关节主动活动度(AROM)、Rowe评分、Walch-Duplay评分、肩关节主观评价(SSV)评分,同时末次随访时采用CT三维重建评估植骨块的位置和吸收情况。结果所有患者术后平均随访12.5个月(6~36个月),均未出现再脱位。术前与末次随访时前屈上举、体侧外旋、内旋、外展90°外旋差异无统计学意义(P>0.05);Rowe评分、Walch-Duplay评分、SSV评分术前分别为(42.2±5.6)分、(31.5±8.0)分、63.9%±6.1%,末次随访时分别为(91.1±3.3)分、(92.6±3.7)分、79.3%±5.0%,术前与末次随访时比较差异均有统计学意义(P<0.05)。末次随访时CT三维重建检查发现29例患者出现不同程度骨吸收;23例患者在术后6~12个月恢复到伤前运动水平。结论对于习惯性肩关节前脱位合并骨缺损的年轻患者,采用全关节镜下Latarjet手术加关节囊修复能较好、较快地恢复肩关节的稳定性,早期疗效好。Objective To assess the short-term radiographic and clinical outcomes of total arthroscopic Latarjet procedure for young activated patients with habitual anterior shoulder dislocation and a marked glenoid bone defect.Methods We retrospectively reviewed the radiographic and clinical outcomes of 37 patients who had undergone a total arthroscopic Latarjet procedure from January 2017 to June 2019 for habitual anterior shoulder dislocation and a marked glenoid bone defect.They were all males,with an average age of 25.4 years(from 18 to 36 years).A total of 18 left and 19 right shoulders were involved.3D CT scans of bilateral shoulders were performed before surgery and the glenoid defects calculated before total arthroscopic Latarjet procedure and repair of anterior joint capsule.Comparisons were made between preoperation and the final follow-up in terms of active range of motion(AROM),Rowe score,Walch-Duplay score and Subjective Shoulder Value(SSV).3D CT reconstruction was conducted at the final follow-up to evaluate the location and absorption of bone grafts.Results The duration of follow-up ranged from 6 to 36 months(average,12.5 months).No recurrent dislocation occurred before the final follow-up.No significant differences were found between preoperation and the final follow-up in anteflexion elevation,external rotation at lateral body,internal rotation or external rotation at abduction 90°(P>0.05).The differences between preoperation and the final follow-up were statistically significant in Rowe score(42.2±5.6 versus 91.1±3.3),Walch-Duplay score(31.5±8.0 versus 92.6±3.7),and SSV score(63.9%±6.1%versus 79.3%±5.0%)(P<0.05).3D CT reconstruction at the final follow-up observed bone absorption in 29 patients;23 patients recovered to their pre-injury sports level 6 to 12 months after surgery.Conclusion In young activated patients with anterior shoulder dislocation and a marked glenoid bone defect,the total arthroscopic Latarjet procedure plus anterior capsular repair can produce excellent early functional and rad

关 键 词：肩脱位 关节镜检查 活动范围 关节 Latarjet手术 骨缺损 

分 类 号：R687.4[医药卫生—骨科学]