关节镜下Bankart损伤修复联合Remplissage填塞术治疗合并Hill-Sachs缺损的成年人复发性肩关节前脱位  

Arthroscopic Bankart repair combined with Reimplissage for the treatment of recurrent anterior dislocation of shoulder in adults with Hill-Sachs defect

作　　者：邢基斯 卢明峰[2] 赵立连 傅楚滢 何利雷[2] XING Ji-si;LU Ming-feng;ZHAO Li-lian;FU Chu-ying;HE Li-lei(Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine,Foshan 528000,Guangdong,China)

机构地区：[1]广州中医药大学附属佛山中医院,广东佛山528000 [2]佛山市中医院运动医学科,广东佛山528000

出　　处：《中国骨伤》2021年第6期497-503,共7页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨关节镜下Bankart损伤修补术联合Remplissage填塞术治疗复发性肩关节前脱位合并Hill-Sachs损伤的方法和临床疗效。方法:回顾性分析2016年3月至2019年3月行关节镜下Bankart损伤修复治疗关节盂骨缺损<20%的复发性肩关节前脱位患者106例,其中男76例,女30例;年龄18~45(27.3±8.6)岁;左肩59例,右肩47例。手术前后采用肩关节主动活动度评估关节活动范围(range of motion,ROM),采用美国肩肘外科协会(American Shoulder and Elbow Surgeons,ASES)评分,Constant-Murley评分及肩关节功能Rowe评分对肩关节功能和稳定性进行评估。结果:所有患者获得随访,均取得满意疗效,术后随访时间21~60(41.5±18.5)个月。1例术后出现感染,再次关节镜清理后感染控制,其余患者均未出现感染、关节腔积血及再脱位等临床并发症。肩关节前屈上举由术前的(158.33±15.72)°提高至末次随访的(169.43±10.04)°,内旋由术前T7(T4-T10)改变至末次随访T8(T5-T10);平均体侧外旋、外展90°外旋分别由术前(58.46±15.51)°及(99.37±14.09)°减小至末次随访的(53.18±14.90)°及(92.52±13.10)°。ASES评分、Constant-Murley评分及Rowe评分均较术前明显改善。结论:关节镜下Bankart损伤修补联合Remplissage填塞术治疗合并Hill-Sachs缺损的成年人复发性肩关节前脱位临床效果满意,虽然外旋功能较术前减弱,但能够有效重建肩关节功能,避免术后再脱位的发生。Objective:To investigate the method and clinical effects of the treatment of recurrent anterior dislocation of shoulder with Hill-Sachs injury by arthroscopic Bankart repair and Remplissage.Methods:From March 2016 to March 2019,106 patients with recurrent anterior dislocation of shoulder with glenoid bone defect less than 20%underwent arthroscopic Bankart repair,including 76 males and 30 females,aged from 18 to 45(27.3±8.6)years,59 cases of left shoulder and 47 cases of right shoulder.Range of motion(ROM),American Shoulder and Elbow Surgeons(ASES)score,Constant-Murley score and Rowe score were used to evaluate shoulder function and stability before and after operation.Results:All patients were followed up,and the duration ranged from 21 to 60 months,with a mean of(41.5±8.5)months.One patient developed infection after operation,and the infection was controlled after arthroscopic debridement again.The remaining patients did not have clinical complications such as infection,intra-articular hematocele and redislocation.Shoulder flexion and lifting increased from(158.33±15.72)°preoperatively to(169.43±10.04)°at the latest follow-up,and internal rotation changed from T7(T4 to T10)preoperatively to T8(T5 to T10)at the latest follow-up;the average lateral external rotation and abduction 90°external rotation decreased from(58.46±15.51)°preoperatively and(99.37±14.09)°to(53.18±14.90)°and(92.52±13.10)°at the latest follow-up,respectively.The ASES score,Constant-Murley score and Rowe score were significantly improved.Conclusion:The clinical effect of rehabilitation of Bankart repair combined with Remplissage under arthroscopy in the treatment of recurrent dislocation of shoulder joint in adults with Hill-Sachs defect is satisfactory.Although the external rotation function is weaker than that before operation,it can effectively reconstruct the shoulder function and avoid the occurrence of dislocation after operation.

关 键 词：关节镜 肩关节 脱位 Hill-sachs损伤 

分 类 号：R684[医药卫生—骨科学]