切开Latarjet手术治疗复发性肩关节前脱位的随访研究  

Follow-up study of open latarjet for recurrent anterior dislocation of shoulder joint

作　　者：郑翰 丁国强[1] 谢鹏 卢冰[1] Zheng Han;Ding Guoqiang;Xie Peng;Lu Bing(Department of Orthopaedics,Sichuan Academy of Medical Sciences Sichuan Provincial People's Hospital,Chengdu 610072,China;School of Medicine and Life Sciences,Chengdu University of Traditional Chinese Medicine,Chengdu 610075,China)

机构地区：[1]四川省医学科学院四川省人民医院骨科,成都610072 [2]成都中医药大学医学与生命科学学院,610075

出　　处：《中华肩肘外科电子杂志》2023年第3期204-211,共8页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：四川省科技厅2022年重大科技专项基金(22ZDYF1682)。

摘　　要：目的分析讨论切开Latarjet手术治疗复发性肩关节前脱位的疗效。方法采用回顾性病例系列研究分析2016年12月至2022年3月符合复发性肩关节前脱位伴肩盂缺损条件的患者,术前记录患侧肩关节功能(前屈上举、体侧外旋、外展90°外旋、内旋),手术通过三角肌胸大肌入路运用Latarjet技术进行重建治疗肩关节复发性前脱位共16例。术后通过门诊随访、电话随访、微信视频随访等方式收集美国肩肘外科协会评分(American shoulder elbow surgeons'form,ASES)、Constant-Murley肩关节功能评分、美国加州大学肩关节评分表(University of California at Los Angeles shoulder rating scale,UCLA)、视觉模拟评分法(visual analogue scale,VAS)以及记录术后肩关节功能,评估患者肩关节疼痛、活动度、肌力及稳定性等情况。结果符合纳入条件患者共16例(随访截至2022年6月),随访4~42个月,平均(27.25±16.43)个月。术后切口均Ⅰ期愈合,无血管、神经损伤等,随访期间,患者无再次脱位发生,肩关节恐惧试验均(-)。其中1例患者术后复查CT见移植骨块吸收,出现纤维愈合(愈合率93%)。末次随访时:ASES评分区间为78.3~100分,平均(89.44±7.59)分(良4例、优12例,评分90分及以上共9例)。Constant-Murley评分区间为89~100分,平均(95.50±2.73)分(优16例,其中>95分4例、90~95分11例、<90分1例)。UCLC评分区间为33~35分,平均(33.63±0.96)分(良11例、优5例)。VAS评分区间为0~2分,平均(1.38±0.96)分。末次随访患者肩关节功能:前屈上举由术前158.75°±4.65°上升至165.00°±4.83°,差异有统计学意义(P<0.01);体侧外旋由术前58.75°±3.42°下降至56.56°±4.37°,差异有统计学意义(P<0.01);外展90°外旋由术前80.00°±3.65°下降至77.81°±3.64°,差异有统计学意义(P<0.05);内旋由术前6.38°±1.63°上升至8.13°±1.82°,差异有统计学意义(P<0.01)。患者随访提示:Latarjet术后患肢外展、外旋功能较前下降,前�Background The shoulder joint(glenohumeral joint)is one of the body's most unstable and frequently dislocated joints from the anatomical and biomechanical characteristics,accounting for about 50%of all joint dislocations.The incidence rate among the general population is about 2%.Shoulder joint instability means that patients repeatedly experience Shoulder joint dislocation,subluxation,or fear of joint prolapse during Shoulder joint activities.It is divided into traumatic Shoulder joint instability and non-traumatic Shoulder joint instability.Traumatic Shoulder joint instability is more common,and most are accompanied by pathological changes such as Shoulder joint bone injury or glenoid lip,Joint capsule ligament injury,or rotator cuff injury.No anatomical healing is obtained after the first dislocation.In the classification,anterior instability of the Shoulder joint is the most common.The first dislocation occurred in patients under ten years old.After Conservative management,the rate of Shoulder joint dislocation was 100%,94%for patients aged 20-30,and 50%for patients aged 30-40.The curative effect of rehabilitation treatment on Shoulder joint dislocation caused by different reasons was that the cure rate for post-traumatic recurrent Shoulder joint dislocation was only 16%.The method of treating recurrent anterior dislocation of the Shoulder joint has been constantly improved and updated in practice.At present,there are many surgical methods in clinical use.Objective To analyze and discuss the effect of open Latarjet operation for recurrent anterior dislocation of the shoulder joint.Methods A retrospective case series study was conducted to analyze patients with recurrent anterior dislocation of the shoulder with shoulder pelvis defect from December 2016 to March 2022.The function of the affected shoulder joint was recorded before surgery(forward flexion and upward lift,lateral external rotation,90°external rotation,and internal rotation with abduction).Sixteen cases of recurrent anterior dislocation of the sh

关 键 词：肩关节复发性前脱位 肩盂缺损 LATARJET 

分 类 号：R687.4[医药卫生—骨科学]