改良关节镜下弹性固定Latarjet手术治疗复发性肩关节前脱位的中期疗效观察  

Mid-term effectiveness of modified arthroscopic suture button fixation Latarjet procedure for treatment of recurrent anterior shoulder dislocations

作　　者：刘修齐 仲鹤鹤 陈方 金瑛 向宽 谢淘 熊华章 吴术红 LIU Xiuqi;ZHONG Hehe;CHEN Fang;JIN Ying;XIANG Kuan;XIE Tao;XIONG Huazhang;WU Shuhong(Department of Orthopedic Surgery,Affiliated Hospital of Zunyi Medical University,Zunyi Guizhou,563000,P.R.China)

机构地区：[1]遵义医科大学附属医院骨科,贵州遵义563000

出　　处：《中国修复重建外科杂志》2024年第6期679-683,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：贵州省科技计划项目(黔科合成果-LC[2023]011)。

摘　　要：目的总结改良关节镜下弹性固定Latarjet手术治疗复发性肩关节前脱位的中期疗效。方法2018年1月—2020年10月,采用改良关节镜下弹性固定Latarjet手术治疗30例复发性肩关节前脱位患者。男19例,女11例;年龄18~41岁,平均27.3岁。肩关节脱位3~7次,平均4.9次;肩关节末次脱位至手术时间3~10 d,平均4.1 d。肩胛盂骨缺损均超过20%。合并Hill-Sachs损伤27例。术前、术后1个月、6个月和末次随访时,采用疼痛视觉模拟评分(VAS)、美国加州大学洛杉矶分校(UCLA)评分、Rowe评分、美国肩肘外科协会(ASES)评分、Walch-Duplay评分及0°外旋、外展90°外旋活动度评价肩关节疼痛及功能。复查肩关节X线片、CT扫描及三维重建,观察喙突骨块在位、愈合吸收及肩胛盂缺损纠正、肩关节退行性改变程度等情况。结果手术时间51~79 min,平均68.4 min。术后切口均Ⅰ期愈合,无神经、血管损伤等并发症发生。患者均获随访,随访时间36~60个月,平均44.6个月。术后VAS评分、UCLA评分、Rowe评分、ASES评分、WalchDuplay评分以及0°外旋、外展90°外旋活动度均较术前改善(P<0.05);术后随时间延长各指标进一步改善,各时间点间差异均有统计学意义(P<0.05)。影像学复查示,术后1 d喙突骨块位于肩胛盂前下方;随访期间无肩关节骨关节炎发生,肩胛盂解剖结构正常,无喙突骨块延迟愈合或不愈合。1例因摔伤后骨折,于术后20个月关节镜下二次探查见喙突骨块塑形良好,肩胛盂平整,无骨块吸收及骨关节炎发生。结论改良关节镜下弹性固定Latarjet手术治疗复发性肩关节前脱位,肩关节功能恢复较好,并发症发生率较低,可获得较好中期疗效。Objective To summarize mid-term effectiveness of modified arthroscopic suture button fixation Latarjet procedure for treatment of recurrent anterior shoulder dislocations.Methods Between January 2018 and October 2020,30 patients with recurrent anterior shoulder dislocations were treated with modified arthroscopic suture button fixation Latarjet procedure.There were 19 males and 11 females with an average age of 27.3 years(range,18-41 years).The shoulder dislocation occurred 3-7 times,with an average of 4.9 times.The time from the last dislocation to operation was 3-10 days,with an average of 4.1 days.Glenoid defects exceeded 20%in all cases.There were 27 cases of Hill-Sachs lesions.The joint pain and function were estimated by visual analogue scale(VAS)score,University of California,Los Angeles(UCLA)score,Rowe score,American Association for Shoulder and Elbow Surgery(ASES)score,Walch-Duplay score,and the range of external rotation at 0°and external rotation at 90°abduction of shoulder before operation and at 1 month,6 months,and last follow-up.The X-ray film,CT scan and three-dimensional reconstruction were reviewed to observe the position,healing,and absorption of the coracoid graft,correction of glenoid defect,and joint degeneration.Results The operation time ranged from 51 to 79 minutes,with an average of 68.4 minutes.All incisions healed without complications such as nerve or blood vessel injury.All patients were followed up 36-60 months with an average of 44.6 months.The VAS score,UCLA score,Rowe score,ASES score,Walch-Duplay score,and the range of external rotation at 0°and external rotation at 90°abduction after operation significantly improved when compared with preoperative values(P<0.05).All indicators further improved with time,and the differences between different time points after operation were significant(P<0.05).Imaging review showed that the coracoid graft was located in the anteroinferior glenoid at 1 day after operation,and no occurrence of shoulder osteoarthritis was found during follow-up

关 键 词：改良弹性固定Latarjet手术 关节镜 复发性肩关节前脱位 中期疗效 

分 类 号：R687.4[医药卫生—骨科学]