关节镜下结合改良线袢固定的“双嵌入式”髂骨移植翻修术治疗肩关节复发性前脱位:初期两年随访结果  

An Arthroscopic“Double-Inlay”Eden-Hybinette Procedure with Modified Suture Button Fixation for the Treatment of Recurrent Anterior Dislocation of the Shoulder Joint:The Result of 2-Year Follow-up

作　　者：邵振兴[1] 张淑涵 蒋艳芳[1] 赵宇晴[2] 程序[1] 罗浩[1] 崔国庆[1] Shao Zhenxing;Zhang Shuhan;Jiang Yanfang;Zhao Yuqing;Cheng Xu;Luo Hao;Cui Guoqing(Department of Sports Medicine,Peking University Third Hospital,Beijing 100191,China;Radiology Department,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院运动医学科,北京100191 [2]北京大学第三医院放射科

出　　处：《中国运动医学杂志》2021年第7期509-517,共9页Chinese Journal of Sports Medicine

基　　金：国家重点研发计划科技冬奥专项基金(2018YFF0301100)。

摘　　要：目的:介绍一种关节镜下结合改良线袢固定的关节镜下"双嵌入式"髂骨移植手术,用于治疗喙突移位术后复发以及患有癫痫的肩关节复发性前脱位术后再复发患者,并总结初期11例患者2年临床及影像学随访结果。方法:本研究对在2016年6月至2018年6月之间接受关节镜下结合改良线袢固定的关节镜下"双嵌入式"髂骨移植手术的11例肩关节复发性前脱位患者进行了初期2年的随访,随访内容包括临床疼痛视觉模拟评分(VAS)、不稳VAS评分、Rowe评分、加州大学洛杉矶分校(UCLA)肩关节评分、肩关节主观评分(SSV),以及术后第1天、术后3个月、术后2年的CT影像学随访,并且记录了相关并发症以及骨性关节炎的发生情况。结果:最终有10例患者纳入本项研究,其中8例为关节镜下喙突移位术后(Bristow-Latarjet)再复发,而这8例患者中有2例患有癫痫;其余两例为关节镜下Bankart修复术后再复发患者,均为癫痫患者。平均随访时间为26±2.1个月。术后2年时,所有患者在疼痛VAS评分(术前5.16±3.71分,术后2年1.00±1.41分,P<0.05)、不稳VAS评分(术前8.16±2.85分,术后2年2.50±3.09分,P<0.05)、Rowe评分(术前27.28±9.65分,术后2年92.20±5.10分,P<0.01)以及肩关节主观评分(术前33.30%±20.54%,术后2年80.83%±8.86%,P<0.01)较术前均有显著改善。而影像学评估方面,术后第一天CT显示骨块位置的优良率达到100%(轴位相上均与关节盂面平齐,En-face相上骨块位于2~6点),术后3个月和术后2年的骨愈合率均为100%,术后关节盂的面积都得到了很好的扩增,并且术后的骨重塑使得整个关节盂逐渐趋向于正常的"梨形"形态。Friedman检验显示不同时间节点关节盂面积存在显著差异(P<0.0001),post-hoc两两比较发现术后1天、术后3个月和术后2年关节盂面积均较术前显著增加(P<0.008);术后2年关节盂面积较术后1天和术后3个月有显著减小的趋势(P<0.008),虽然有显著Objective To introduce an arthroscopic "double-inlay" Eden-Hybinette procedure with modified suture button fixation for the revision of failed Bristow-Latarjet and failed Bankart repair in patients with seizure.Methods A total of 11 patients who received arthroscopic"double-inlay"EdenHybinette procedure with modified suture button fixation between June 2016 to June 2018 were followed up for at least two years and investigated using the visual analogue scale(VAS) for pain,VAS for instability, the University of Califonia at Los Angeles(UCLA) shoulder rating scale, Rowe score and Subjective Shoulder Value(SSV). One day,3 months and 2 years after the operation,radiological assessment on 3 D CT scan was performed. Moreover,postoperative complications and the incidence of osteoarthritis were recorded.Results Eventually ten patients finished the study,eight of whom recurred after the arthroscopic Bristow-Latarjet procedure,with 2 suffering from seizure. The other two both suffered from seizure and recurred after the arthroscopic Bankart repair. The mean follow-up time was 26± 2.1 months. All patients improved significantly in the average VAS for pain(5.16 ± 3.71 vs. 1.00 ±1.41,P<0.05),VAS for instability(8.16 ± 2.85 vs. 2.50 ± 3.09,P<0.05),Rowe score(27.28 ± 9.65 vs. 92.20 ± 5.10,P<0.01),and subjective shoulder score(SSV)(33.30% ± 20.54% vs. 80.83% ±8.86%,P<0.01) at 2 years after operation. For the radiology assessment,the CT image of the first day postoperatively showed 100% excellent bone position(flush with the glenoid surface in the axial view and at 2~6 o’clock in the En-face view),100% bone healing at 3 months and 2 years postoperatively. And postoperative bone remodeling resulted in a gradual convergence of the glenoid to a normal"pear-shaped"shape. Friedman’s test showed a significant difference in the average glenoid area at different time points(P<0.0001),and post-hoc test revealed a significant increase in postoperative glenoid area at 1 day,3 months,and 2 years compared with before the operation

关 键 词：肩关节复发性前脱位 喙突移位术 髂骨移植术 线袢固定 癫痫 

分 类 号：R687.4[医药卫生—骨科学]