复发性肩关节前脱位关节镜手术治疗进展  

Progress on arthroscopic surgery for recurrent anterior shoulder dislocation

作　　者：张明涛 张广瑞 周建平 吴定 刘嘉鑫 贾耀飞 韵向东[1,2] ZHANG Ming-tao;ZHANG Guang-rui;ZHOU Jian-ping;WU Ding;LIU Jia-xin;JIA Yao-fei;YUN Xiang-dong(不详;Department of Orthopaedics,the Second Hospital of Lanzhou University,Lanzhou 730030,Gansu,China)

机构地区：[1]兰州大学第二医院骨科,甘肃兰州730030 [2]甘肃省骨关节疾病研究重点实验室,甘肃兰州730030

出　　处：《中国骨伤》2021年第5期478-484,共7页China Journal of Orthopaedics and Traumatology

摘　　要：复发性肩关节前脱位的手术治疗是运动损伤医学领域中的一个难题,其主要原因在于无法较好地恢复肩关节动力性及骨性约束。目前国内外大多采用关节镜手术治疗,术后总体效果满意,但具体术式的选择仍存在较大争议。临床中需根据关节盂及肱骨头骨性缺损的有无及大小,选择不同方案治疗。笔者建议:无关节盂骨性缺损或关节盂骨性缺损<20%,选用Bankart术;关节盂骨性缺损<20%伴Hill–Sachs骨性缺损<40%,选用Bankart术联合Remplissage术或ASA术;关节盂骨性缺损20%~25%,选用“Sling”术;关节盂骨性缺损25%~40%,选用Bristow-Latarjet术;关节盂或Hill–Sachs骨性缺损>40%或Bristow-Latarjet术修复失败,选用骨移植术。此外,若存在盂肱韧带肱骨撕脱(humeral avulsion of glenohumeral ligaments,HAGL)损伤,则选用HAGL损伤修复术。除考虑骨性缺损这一重要因素外,还需结合患者年龄、运动水平及术者技术来综合选择最佳术式。The surgical treatment of recurrent anterior shoulder dislocation is a difficult problem in the field of sports injury medicine.The main reason focus on dynamic and osseous constraints of shoulder joint could not recover well.At present,arthroscopic surgery is used at home and abroad,and could receive statisfied postoperative effect,but the choice of specific surgical methods is still controversial.According to presence and size of glenoid and humeral skull defects,different treatments should be selected in clinic.The author recommends that no articular glenoid defect or glenoid defect<20%,choose Bankart surgery;articular glenoid defect<20%with Hill-Sachs bone defect<40%,choose Bankart surgery combined with remplissage surgery or ASA surgery;Glenoid defect 20%to 25%,choose"Sling";Glenoid defect 25%to 40%,choose Bristow-Latarjet;Glenoid or Hill-Sachs bone defect>40%or Bristow-Latarjet if the surgical repair fails,bone grafting is used.In addition,if(humeral avulsion of glenohumeral ligaments,HAGL)injury existed,HAGL injury repair should be used.In addition to considering the important factor of bone defects,it is necessary to combine patient's age,exercise level and surgeon's technique to comprehensively select the best surgical method.

关 键 词：肩关节 关节脱位 关节镜 综述 

分 类 号：R684.7[医药卫生—骨科学]