LU-tarjet一致弧技术在治疗复发性肩关节脱位伴关节盂巨大缺损中的应用  

Application of LU-tarjet congruent-arc technique in treatment of recurrent shoulder dislocation with huge glenoid defect

作　　者：王月[1] 刘欣伟 闫增龙 于瀚 王山林 孙诗博 白希壮[3] 陆伟[4] WANG Yue;LIU Xinwei;YAN Zenglong;YU Han;WANG Shanlin;SUN Shibo;BAI Xizhuang;LU Wei(Department of Sports Medicine and Joint Surgery,the First Clinical Hospital Affiliated to China Medical University,Shenyang Liaoning,110001,P.R.China;Department of Orthopedics,Northern Theater Command General Hospital of Chinese PLA,Rescue Center of Severe Wound and Trauma of Chinese PLA,Shenyang Liaoning,110016,P.R.China;The 3rd Department of Orthopedics,Liaoning Provincial People’s Hospital,Shenyang Liaoning,110016,P.R.China;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]中国医科大学附属第一临床医院运动医学关节外科,沈阳110001 [2]中国人民解放军北部战区总医院骨科全军重症战创伤救治中心,沈阳110016 [3]辽宁省人民医院骨三科,沈阳110016 [4]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672-678,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：2021沈阳市科学技术计划-公共卫生研发专项(21-173-9-77)。

摘　　要：目的探讨关节镜下喙突有限截骨线袢固定Latarjet(limit unique coracoid osteotomy suture button fixation Latarjet,LU-tarjet)一致弧(congruent-arc,CA)技术(LU-tarjet-CA)治疗复发性肩关节脱位伴关节盂巨大缺损的早期疗效。方法回顾分析2021年1月—2023年12月收治且符合选择标准的12例复发性肩关节脱位伴关节盂巨大缺损患者临床资料,均采用关节镜下LU-tarjet-CA治疗。其中男8例,女4例;年龄20~40岁,平均30.4岁。肩关节盂骨缺损范围为30%~40%,平均35.5%。出现症状至入院时间1~36个月,平均18.5个月。采用术前及术后3、6、12个月美国加州大学洛杉矶分校(UCLA)评分、美国肩肘外科协会(ASES)评分、WalchDuplay评分和Rowe评分评价肩关节疼痛及功能;术后3、6、12个月CT三维重建评估喙突骨块愈合塑形情况;末次随访时评价患者主观满意度。结果术后切口均Ⅰ期愈合,无切口感染、神经损伤等并发症发生。12例患者均获随访12个月。术后发生关节内痤疮丙酸杆菌感染1例,给予一期关节镜清理及抗炎处理后恢复正常;术后3个月CT三维重建复查发现1例发生喙突完全吸收;这2例均未发生再脱位。其余患者喙突均有部分吸收现象,但表现出局部塑形,能填补术前缺损区域,喙突与关节盂之间骨性愈合。末次随访时,患者对疗效非常满意9例(75%)、满意3例(25%);3例满意患者是由于术后功能锻炼欠佳,肩关节僵硬,但不影响正常生活。术后3、6、12个月UCLA评分、ASES评分、Walch-Duplay评分和Rowe评分均显著优于术前,且术后随时间延长各评分均进一步改善,手术前后各时间点间比较差异均有统计学意义(P<0.05)。结论关节镜下LU-tarjet-CA技术治疗复发性肩关节脱位伴关节盂巨大缺损,可以实现骨性阻挡、填补骨缺损的效果,达到防止肩关节脱位的作用,提高患者生活质量,使肩关节获得良好功能和稳定性。Objective To investigate the early effectiveness of the limited unique coracoid osteotomy suture button fixation Latarjet(LU-tarjet)-congruent-arc(CA)technique(LU-tarjet-CA)in treating recurrent shoulder dislocations with huge glenoid defect.Methods The clinical data of 12 patients with recurrent shoulder dislocation and huge glenoid defect who met the selection criteria and treated with arthroscopic LU-tarjet-CA between January 2021 and December 2023 were retrospectively analyzed.The cohort included 8 males and 4 females,aged 20-40 years with an average age of 30.4 years.The range of glenoid bone loss was 30%-40%,with an average of 35.5%.The time from symptom onset to hospital admission ranged from 1 to 36 months,with an average of 18.5 months.The University of California Los Angeles(UCLA)score,American Association for Shoulder and Elbow Surgery(ASES)score,Walch-Duplay score,and Rowe score were used to evaluate shoulder function preoperatively and at 3,6,and 12 months postoperatively.CT threedimensional(3D)reconstruction was used to assess coracoid healing and plasticity at 3,6,and 12 months postoperatively.Subjective satisfaction of patient was recorded at last follow-up.Results All incisions healed by first intention,with no incision infection or nerve injury.All 12 patients were followed up 12 months.One patient developed Propionibacterium acnes infection within the joint postoperatively and recovered after initial arthroscopic debridement and antiinflammatory treatment.At 3 months after operation,CT 3D-reconstruction showed 1 case of complete coracoid absorption;neither of these two patients experienced redislocation.The remaining patients exhibited partial coracoid absorption but displayed local reshaping,filling the preoperative defect area,and bony fusion between the coracoid and the glenoid.At last follow-up,9 patients(75%)were very satisfied with the outcome,and 3 patients(25%)were satisfied;the satisfied patients experienced postoperative shoulder stiffness caused by suboptimal functional exercise but

关 键 词：一致弧技术 喙突有限截骨线袢固定Latarjet手术 复发性肩关节脱位 关节盂缺损 

分 类 号：R687.4[医药卫生—骨科学]