弹性固定骨遮挡方法治疗肩关节复发脱位的手术意外及术后并发症  

Surgical accidents and postoperative complications of recurrent shoulder dislocation treated by suture button fixation with bone occlusion

作　　者：卜晗[1] 陆伟[2] BU Han;LU Wei(Department of Sports Medicine,Guangdong Provincial Hospital of Chinese Medicine,Zhuhai Hospital,Zhuhai Guangdong,519015,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]广东省中医院珠海医院运动医学科,广东珠海519015 [2]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684-690,共7页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结弹性固定骨遮挡方法治疗肩关节复发脱位的手术意外和术后并发症及解决方案,为临床提供参考。方法回顾分析2017年7月—2023年4月采用改良关节镜下Latarjet弹性固定骨遮挡方法治疗的16例肩关节复发脱位患者临床资料。其中男15例,女1例;年龄16~45岁,平均26岁。入院检查:肩关节活动范围正常;肩关节恐惧试验阳性;CT检查En-face面测量关节盂骨缺损10%~20%,平均13.4%;MRI检查示骨性Bankart损伤。病程2~20年,平均7.1年。肩关节脱位8~45次,平均17.4次;肩关节均不稳定。记录术中出现的手术意外及术后并发症发生情况和应对措施及结果。结果术后患者切口均Ⅰ期愈合,无切口感染及血管损伤等并发症发生。16例均获随访,随访时间1~7年,平均3.6年。所有患者均未出现肩关节再脱位。出现4类术中手术意外和2类术后并发症,均发生在该技术实施早期。术中意外包括喙突截取过大通过肩胛下肌困难1例,使用交换棒或手指送过肩胛下肌劈裂口处理;喙突骨折2例,其中1例保守康复治疗,另1例缝合联合腱基底部,过隧道后固定;关节盂骨隧道太浅出现关节盂软骨劈裂1例,使用免打结锚钉固定;后方袢钢板固定异常2例,其中1例重新固定,另1例翻修。术后并发症包括喙突骨块移位1例,给予保守肱二头肌康复治疗,避免过早外旋活动;健侧上肢桡神经及患侧肌皮神经损伤1例,给予口服药物及理疗。上述情况经相应处理后均恢复良好。结论弹性固定骨遮挡方法治疗肩关节复发脱位安全性较好,术中在喙突截取、关节盂隧道钻取时需小心操作,尤其在固定环节需要重点注意。Objective To summarize the surgical accidents and postoperative complications of the treatment of recurrent shoulder dislocation by suture button fixation and bone occlusion,and to provide clinical reference.Methods The clinical data of 16 patients with recurrent shoulder dislocation treated with modified arthroscopic Latarjet suture button fixation and bone occlusion between July 2017 and April 2023 were retrospectively analyzed.Among them,15 were male and 1 was female.The age ranged from 16 to 45 years,with an average of 26 years.Admission examination showed the range of motion of shoulder joint was normal;the shoulder joint fear test was positive;En-face CT scan measured 10%-20%of the glenoid defects,averaging 13.4%;and MRI examination revealed bone Bankart injury.The disease duration ranged from 2 to 20 years,with an average of 7.1 years.The shoulder joint was dislocated 8-45 times,with an average of 17.4 times,and the shoulder joint was unstable.The occurrence of surgical accidents and postoperative complications as well as corresponding measures and outcomes were recorded.Results All the incisions healed by first intention without any complications such as incision infection or vascular injury.All 16 cases were followed up for an average of 3.6 years(range,1-7 years),and no shoulder redislocation occurred.Four types of intraoperative surgical accidents and two types of postoperative complications occurred in the early stage of implementation of the technique.Intraoperative surgical accidents included 1 case of difficulty in passing subscapular muscle through coracotomy with large size,which was treated with exchange rod or finger through subscapular muscle split;2 cases of coracoidal process fracture,of which 1 case was treated conservatively,and the other case was sutured to the base of tendon and fixed through tunnel;1 case of glenoid fracture occurred in the glenoid tunnel,which was fixed with knot-free anchors;the posterior loop plate fixation was abnormal in 2 cases,of which 1 case was re-fixed and the

关 键 词：弹性固定 骨遮挡 肩关节复发脱位 手术意外 并发症 

分 类 号：R687.4[医药卫生—骨科学]