LU-tarjet手术治疗复发性肩关节前脱位的中期疗效  

Mid-term effectiveness of LU-tarjet procedure for recurrent anterior shoulder dislocation

作　　者：吴冰[1] 陈派 卢奕森 梁新枝 梁达强 龙则灵 李皓[1] 柳海峰[1] 欧阳侃[1] 陆伟[1] WU Bing;CHEN Pai;LU Yisen;LIANG Xinzhi;LIANG Daqiang;LONG Zeling;LI Hao;LIU Haifeng;OUYANG Kan;LU Wei(Department of Sports Medicine,the Second People’s Hospital of Shenzhen,the First Affiliated Hospital of Shenzhen University,Shenzhen Guangdong,518025,P.R.China)

机构地区：[1]深圳大学第一附属医院(深圳市第二人民医院)运动医学科,广东深圳518025

出　　处：《中国修复重建外科杂志》2024年第6期646-654,共9页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(82072515);广东省基础与应用基础研究基金联合基金(2023A1515110483)。

摘　　要：目的探讨喙突有限截骨线袢固定Latarjet(LU-tarjet)手术治疗复发性肩关节前脱位的中期疗效。方法2017年3月—2019年2月,采用关节镜下LU-tarjet手术治疗56例复发性肩关节前脱位患者。男44例,女12例;年龄18~41岁,平均26.3岁。肩关节脱位2~16次,平均7.5次。初次脱位至该次手术时间6个月~13年,中位时间4.6年。术前肩关节恐惧试验及再复位试验均为阳性;关节松弛度Beighton评分1~7分,平均4.1分;肩关节不稳定严重程度指数评分(ISIS)5~10分,平均7.8分。患侧肩胛盂骨缺损面积15%~32%,平均22.4%,患者均合并不同程度Hill-Sachs损伤,Bankart损伤修复后再脱位6例。记录手术时间、切口愈合以及相关并发症发生情况。比较手术前后肩关节活动度(前屈、后伸、外展、体侧外旋、外展90°外旋和内旋)及前屈、外展、外旋、内旋活动时肌力,肩关节功能美国肩肘外科协会(ASES)评分、Rowe评分及WalchDuplay评分。通过X线片及三维CT分析移植喙突骨块位置、骨块愈合及塑形、肩胛盂骨缺损修复程度、肩关节退行性变化等。结果手术均顺利完成,手术时间42~98 min,平均63.0 min;切口均Ⅰ期愈合。患者均获随访,随访时间5~7年,平均6.3年。随访期间2例外伤导致肩关节半脱位、1例肩关节反复疼痛,余无其他相关并发症发生。末次随访时,肩关节前屈、后伸、外展、体侧外旋、外展90°外旋及内旋活动度以及前屈、外展、外旋、内旋活动时肌力与术前比较,差异均无统计学意义(P>0.05);肩关节功能ASES评分、Rowe评分及Walch-Duplay评分均较术前提高(P<0.05)。影像学复查示,移植喙突骨块垂直方向位置居中53例(94.64%)、偏上2例(3.57%)、偏下1例(1.79%);内外位置与肩胛盂齐平49例(87.50%)、偏内2例(3.57%)、偏外5例(8.93%)。术后喙突骨块体积呈先减小后增大趋势,其中术后6个月及1年时体积小于其他时间点,差异有统计学意义(P<0.05)。术Objective To evaluate the mid-term effectiveness of limited unique coracoid osteotomy suture button fixation Latarjet(LU-tarjet)procedure in treatment of recurrent anterior shoulder dislocation.Methods Between March 2017 and February 2019,56 patients with recurrent shoulder dislocation were treated with arthroscopic LU-tarjet procedure.There were 44 males and 12 females with an average age of 26.3 years(range,18-41 years).Shoulder joint dislocation occurred 2-16 times,with an average of 7.5 times.The time from the initial dislocation to operation ranged from 6 months to 13 years,with a median of 4.6 years.Preoperative shoulder joint fear test and re-reduction test were positive in all patients.The Beighton score of joint relaxation ranged from 1 to 7,with an average of 4.1.The shoulder Instability Severity Index Score(ISIS)ranged from 5 to 10,with an average of 7.8.The size of glenoid defects on the affected side ranged from 15%to 32%(mean,22.4%).All patients had Hill-Sachs injuries of varying degrees.Six patients had re-dislocation after Bankart surgery.The operation time,incision healing,and postoperative complications were recorded.The range of motion(shoulder flexion,extension,abduction,external rotation,90°external rotation,and internal rotation)and muscle strength in shoulder flexion,abduction,external rotation,and internal rotation)of shoulder joint were compared between pre-and post-operation.The improvement of shoulder function was evaluated using the American Association for Shoulder and Elbow Surgery(ASES)score,Walch-Duplay score,and Rowe score.X-ray films and three-dimensional CT were used to analyze the location,healing,and remolding of bone graft,the repair of glenoid defect,and degenerative changes of the shoulder joint.Results All operations were successfully completed.The operation time ranged from 42 to 98 minutes,with an average of 63 minutes.All incisions healed by first intention.All patients were followed up 5-7 years(mean,6.3 years).During follow-up,2 patients experienced shoulder subluxat

关 键 词：LU-tarjet手术 肩关节前脱位 复发性脱位 中期疗效 

分 类 号：R687.4[医药卫生—骨科学]