关节镜下自体髂骨植骨双袢弹性固定治疗复发性肩关节前脱位合并关节盂巨大骨缺损  

Effectiveness of arthroscopic autologous iliac bone grafting with double-row elastic fixation for recurrent anterior shoulder dislocation with massive glenoid bone defect

作　　者：陈岳明 邓婷[2] 唐琪[1] 刘骞[1] 周鼎 唐得洲 翟龙祥 许镇木 朱威宏[1] CHEN Yueming;DENG Ting;TANG Qi;LIU Qian;ZHOU Ding;TANG Dezhou;ZHAI Longxiang;XU Zhenmu;ZHU Weihong(Department of Orthopedics,the Second Xiangya Hospital,Central South University,Changsha Hunan,410011,P.R.China;Clinical Nursing Teaching and Research Section,the Second Xiangya Hospital,Central South University,Changsha Hunan,410011,P.R.China;Department of Orthopedics,the Hospital of Qingdao Binhai University,Qingdao Shandong,266000,P.R.China)

机构地区：[1]中南大学湘雅二医院骨科,长沙410011 [2]中南大学湘雅二医院临床护理学教研室,长沙410011 [3]青岛滨海学院附属医院骨科,山东青岛266000

出　　处：《中国修复重建外科杂志》2023年第5期533-537,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨关节镜下自体髂骨植骨双袢弹性固定治疗复发性肩关节前脱位合并关节盂巨大骨缺损的疗效。方法2018年1月—2021年12月,采用关节镜下自体髂骨植骨双袢弹性固定治疗16例复发性肩关节脱位合并关节盂巨大骨缺损男性患者。患者初次脱位年龄14~29岁,平均18.4岁;初次脱位原因:摔伤5例,运动损伤11例;脱位4~15次,平均8.3次。左肩5例,右肩11例。该次入院时年龄17~37岁,平均25.1岁。术前肩关节不稳严重程度(ISIS)评分为(5.8±2.1)分,Beighton评分为(4.3±2.6)分。采用美国加州大学洛杉矶分校(UCLA)肩关节评分、Constant评分、美国肩肘外科医师协会(ASES)评分、Rowe评分评估肩关节功能改善情况,基于CT图像观测术后关节盂骨缺损修复程度。结果术后患者切口均Ⅰ期愈合,无切口感染及神经血管损伤等并发症发生。患者均获12个月随访。术后12个月UCLA评分、Constant评分、ASES评分以及Rowe评分均较术前改善,差异有统计学意义(P<0.05)。CT复查示术后即刻以及6、12个月关节盂骨缺损程度均较术前减小,差异有统计学意义(P<0.05);12个月时移植骨块均已与关节盂骨性愈合。结论关节镜下自体髂骨植骨双袢弹性固定治疗复发性肩关节前脱位合并关节盂巨大骨缺损安全,早期疗效良好。Objective To investigate the effectiveness of arthroscopic autologous iliac bone grafting with doublerow elastic fixation in treatment of recurrent anterior shoulder dislocation combined with massive glenoid bone defects.Methods Between January 2018 and December 2021,16 male patients with recurrent anterior shoulder dislocation combined with massive glenoid bone defects were treated with arthroscopic autogenous iliac bone grafting and doublerow elastic fixation.The patients were 14-29 years old at the time of the first dislocation,with an average age of 18.4 years.The causes of the first dislocation included falling injury in 5 cases and sports injury in 11 cases.The shoulders dislocated 4-15 times,with an average of 8.3 times.The patients were 17-37 years old at the time of admission,with an average age of 25.1 years.There were 5 left shoulders and 11 right shoulders.The preoperative instability severity index(ISIS)score of the shoulder joint was 5.8±2.1,and the Beighton score was 4.3±2.6.The University of California Los Angeles(UCLA)score,Constant score,American Shoulder and Elbow Surgeons(ASES)score,and Rowe score were used to evaluate shoulder function,and the degree of the glenoid bone defect repair was observed based on CT after operation.Results All incisions healed by first intention,and no complication such as incision infection or neurovascular injury occurred.The patients were followed up 12 months.At 12 months after operation,UCLA score,Constant score,ASES score,and Rowe score all significantly improved when compared with the scores before operation(P<0.05).CT imaging showed the degree of glenoid bone defect was significantly smaller at immediate,6 and 12 months after operation when compared with that before operation(P<0.05),and the bone blocks healed with the scapula,and bone fusion had occurred at 12 months.Conclusion Arthroscopic autologous iliac bone grafting with double-row elastic fixation is a safe treatment for recurrent anterior shoulder dislocation combined with massive glenoid bone defec

关 键 词：复发性肩关节前脱位 关节盂骨缺损 髂骨植骨 Latarjet术 关节镜 

分 类 号：R687.4[医药卫生—骨科学]