关节镜下髂骨游离悬吊植骨治疗肩关节复发性脱位  

Arthroscopic suspension fixation of free iliac bone graft for treatment of recurrent shoulder dislocation

作　　者：王东昕[1] 李盛海 李靖年[1] 杨梁[1] WANG Dong-xin;LI Sheng-hai;LI Jing-nian;YANG Liang(Department of Traumatic Orthopedics,The Second Affiliated Hospital,Dalian Medical University,Dalian 116023,China;Department of Orthopedics,The Third Affiliated Hospital,Dalian Medical University,Dalian 116200,China)

机构地区：[1]大连医科大学附属第二医院创伤骨一科,辽宁大连116023 [2]大连医科大学附属第三医院骨外科,辽宁大连116200

出　　处：《中国矫形外科杂志》2021年第8期735-737,741,共4页Orthopedic Journal of China

摘　　要：[目的]介绍取自体髂骨关节盂游离悬吊植骨治疗肩关节复发性脱位的手术技术及短期疗效。[方法]2013年3月~2019年3月,采用关节镜下自体髂骨关节盂游离悬吊植骨结合Bankart修补和Remplissage治疗肩关节复发性脱位患者27例。取髂骨块备用。常规建立肩关节后入路、前入路和前上入路,将关节盂前方盂唇破损处骨床予刨刀充分新鲜化。预穿4根PDS缝线,分别穿过髂骨块所钻2孔后,长直血管钳夹持髂骨块,送至关节腔内,放置于关节盂前下方,穿过髂骨块所钻2孔的缝线分别打结,固定髂骨块于关节盂前下方。将盂唇复合体在髂骨块表面,向前上拉合紧缩缝合固定于关节盂前下方足印区。[结果]27例患者均得到随访。植骨块愈合时间6~8周。没有并发症发生。患者满意率100%,无再脱位患者,所有患者均恢复到伤前的工作或运动状态,恐惧试验均阴性。末次随访肩关节UCLA评分(34.22±0.73)分,Constant评分(91.53±2.32)分。[结论]关节镜下髂骨游离悬吊植骨治疗肩关节复发性脱位的短期疗效满意,无再脱位患者。[Objective]To introduce the surgical technique and short-term clinical outcomes of arthroscopic suspension fixation of free bone autograft of iliac bone block for recurrent shoulder dislocation.[Methods]From March 2013 to March 2019,27 patients underwent arthroscopic suspension fixation of free bone autograft of iliac bone block,combined with Bankart repair and Remplissage repair for recurrent shoulder dislocation.After a bone block autograft was harvested from the iliac for further use,the posterior,anterior,and anterior superior portals of the shoulder were established routinely.The bone bed at the anterior glenoid was fully freshened with a shaver.Pre-thread 4 PDS sutures were thrilled through the 2 drilled holes on the iliac bone block,then the iliac bone block was clamped by the long straight clamp to sent into the joint cavity,placed in the front and lower part of the glenoid.The sutures of the 2 holes were knotted separately to fix the iliac bone block in the anterior and inferior glenoid.The labrum complex was placed on the surface of the iliac bone block and fixed on the anterioinferior foot print area of the glenoid.[Results]All 27 patients were followed up with healing time of the bone graft of 6~8 weeks.No complications occurred in anyone of them.The patient satisfaction rate was 100%,and no re-dislocation happened in anyone of them.All patients returned to their pre-injury work or exercise state,and the fear test was negative.At the latest follow-up,the UCLA score of the shoulder joint was(34.22±0.73),and the Constant score was(91.53±2.32).[Conclusion]The arthroscopic suspension fixation of free bone autograft of iliac bone block is feasible with satisfactory short-term clinical outcomes for recurrent shoulder dislocation,without re-dislocation.

关 键 词：肩关节复发性脱位 髂骨植骨 关节镜 

分 类 号：R687.4[医药卫生—骨科学]