经肩胛下肌入路镜下治疗肩关节习惯性前脱位  

Arthroscopic treatment of habitual anterior shoulder dislocation through subscapularis portal

作　　者：张强 张抒 胡宏伟 ZHANG Qiang;ZHANG Shu;HU Hong-wei(Department of Orthopedics,The 960^(th) Hospital,Joint Logistics Support Force of PLA,Jinan 250031,China)

机构地区：[1]中国人民解放军联勤保障部队第九六〇医院骨科,山东济南250031

出　　处：《中国矫形外科杂志》2024年第24期2276-2280,共5页Orthopedic Journal of China

摘　　要：[目的]介绍经肩胛下肌入路镜下治疗肩关节习惯性前脱位的手术技术和初步临床结果。[方法]采用全身麻醉,取健侧卧位,患肢外展40°位悬吊牵引。前上入路置入关节镜。镜下使用16号套管穿刺针、1.0 mm克氏针及不同直径的自制套筒建立经肩胛下肌入路,该入路位于经喙突的肱骨干平行线上、喙突远端2 cm。通过前上侧入路进行松解、新鲜化、标记锚钉位置等操作。通过经肩胛下肌入路由远向近依次置入2.8 mm锚钉,最远端的锚钉要求位于5∶30(右肩)或6∶30(左肩)位。按照常规操作修复撕裂的盂唇及关节囊。[结果]所有患者的手术均顺利完成,未出现感染、血管神经损伤等并发症。其中,25例平均随访时间(12.0±0.3)个月。与术前相比,术后12个月肩关节的ASES评分[(64.8±7.9),(95.0±3.9).P<0.001]和Rowe评分[(42.4±6.9),(92.4±6.8),P<0.001]均显著改善。术后肩关节功能的优良率为100%。[结论]经肩胛下肌入路镜下治疗肩关节习惯性前脱位技术可行,有利于锚钉置入,初步临床效果满意。[Objective]To introduce the surgical technique and preliminary clinical results of arthroscopic treatment of habitual anteri-or glenohumeral dislocation through the subscapularis portal.[Methods]After general anesthesia,the patients was placed in supine posi-tion with the affected limb suspended at 40°of abduction,and the arthroscopy was inserted through the anterosuperior portal.Under ar-throscopic vision,a 16 gauge puncture needle,followed by a 1.0 mm Kirschner wire with self-made sleeves in different diameters were in-serted to establish the the subscapularis portal,with a tuber 4 mm in diameter placed.The anterosuperior portal was used to release,refreshand marke the positions of the anchors,while the subscapularis portal was used to insert the 2.8 mm anchors sequentially,with the farthestanchor located at 5∶30(right shoulder)or 6∶30(left shoulder)position.The glenoid labrum and capsule were repair with the routine tech-niques.[Results]All the patients underwent the arthroscopic procedures successfully without complications such as infection or vascularand nerve damage.Of them,25 patients were followed up for an average of(12.0±0.3)months.Compared with those preoperatively,theASES score[(64.8±7.9),(95.0±3.9),P<0.001]and Rowe score[(42.4±6.9),(92.4±6.8),P<0.001]significantly improved at 12 months postsurgery.The excellent rate of postoperative shoulder joint function was of 100%.[Conclusion]This arthroscopic technique using subscapu-laris portal for treatment of habitual anterior glenohumeral dislocation is feasible and beneficial for anchor placement,does achieve satisfac-tory primary clinical outcomes.

关 键 词：关节镜 肩关节 脱位 入路 

分 类 号：R684.7[医药卫生—骨科学]