体外冲击波在肩关节镜下Bankart损伤修复联合Remplissage手术患者康复治疗中的应用  

Application of extracorporeal shock wave for rehabilitation of patients treated by arthroscopic repair of Bankart injury combined with Remplissage procedure

作　　者：李乔 单战 吴京春 王丹 薛剑[1] LI Qiao;SHAN Zhan;WU Jingchun;WANG Dan;XUE Jian(Department of Second Surgery,Armed Police Force Guangdong Provincial Corps Hospital,Guangzhou,Guangdong 510000,China)

机构地区：[1]武警广东省总队医院外二科,广州510000

出　　处：《中国骨科临床与基础研究杂志》2021年第4期145-152,共8页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：广东医学科研基金(B2019145)。

摘　　要：目的探讨肩关节镜下Bankart损伤修复联合Remplissage手术患者运用体外冲击波进行术后康复治疗的效果。方法回顾性分析2017年3月-2019年12月武警广东省总队医院收治的47例关节镜下肩关节Bankart损伤修复联合Remplissage手术患者的临床资料。按是否在术后康复治疗中使用体外冲击波,将患者分为观察组(n=27)和对照组(n=20),对照组行常规功能锻炼,观察组在此基础上进行体外冲击波治疗(术后2周开始,每周1次,持续4周)。评估术后疼痛症状、肩关节活动度和关节功能变化,比较两组疗效差异。结果随访时间12~28个月,平均随访时间17.9个月。随访期间未发生感染、神经损伤、创伤性关节炎、肩关节再脱位并发症。两组术后3个月VAS评分及末次随访美国肩肘外科协会(ASES)评分、Rowe评分均较术前改善(P<0.05),但观察组改善更明显,两组比较,差异均有统计学意义(P<0.05);术后6个月对照组体侧外旋及外展90°外旋活动度低于术前,观察组基本恢复到术前水平,两组比较,差异有统计学意义(P<0.05)。结论肩关节镜下Bankart损伤修复联合Remplissage手术患者术后采用冲击波治疗可改善患者疼痛症状,利于肩关节外旋、外展90°外旋活动度恢复,有效促进肩关节功能康复。Objective To explore the effects of extracorporeal shock wave therapy(ESWT)for postoperative rehabilitation of patients treated by arthroscopic repair of Bankart injury combined with Remplissage procedure.Methods Clinical data of 47 patients who underwent arthroscopic repair of Bankart injury combined with Remplissage procedure in Armed Police Force Guangdong Provincial Corps Hospital from March 2017 to December 2019 were analyzed retrospectively.Patients were divided into observation group(n=27)and control group(n=20)according to whether using ESWT during the postoperative rehabilitation.Patients in control group were performed regular functional exercise,while patients in group were performed ESWL(beginning at 2 weeks postoperatively,once a week,continuous 4 times in total)based on regular rehabilitation methods.Changes of postoperative pain,range of motion(ROM)of shoulder and shoulder functions were evaluated,and differences between two groups were compared.Results All patients were followed up from 12 to 28 months,with the average of 17.9 months.No complications such as infection,nerve injury,traumatic arthritis or redislocation occurred during the follow-up.Visual analog scale(VAS)score at 3 months after surgery,as well as American shoulder and Elbow Surgeons(ASES)score,Rowe score at the latest follow-up were all improved when compared with preopeatively ones(P<0.05),and those postoperative indicators in observation group were all better than those in control group,difference between two groups showed statistical significance(P<0.05).At 6 months postoperatively,ROM of shoulder external rotation and external rotation at 90 degree abduction in control group were lower than the preoperative ones(P<0.05),while the ROM in observation group basically recovered to preoperative levels(P>0.05);There were statistical differences between two groups(P<0.05).Conclusion ESWT after arthroscopic Bankart injury repair combined with Remplissage procedure could relieve postoperative pain,is beneficial to the recovery of ROM of

关 键 词：肩关节 关节脱位 修复外科手术 高能量冲击波 关节镜检查 康复 

分 类 号：R684.73[医药卫生—骨科学] R493.21[医药卫生—外科学]