关节镜下自体骨软骨移植术与肩胛下肌强化缝合术治疗复发性肩关节前脱位合并肩胛盂骨性损伤小于20%的疗效比较  

Comparison of arthroscopic autologous osteochondral transfer and arthroscopic subscapularis augmentation for recurrent anterior shoulder dislocation complicated with scapular glenoid bone injury less than 20%

作　　者：方森 张明涛 梁钧文 杨旭东 道吉才让 李明春 年稚轩 韵向东[1,2] Fang Sen;Zhang Mingtao;Liang Junwen;Yang Xudong;Daoji Cairang;Li Mingchun;Nian Zhixuan;Yun Xiangdong(Department of Orthopaedics,The Second Hospital of Lanzhou University,Lanzhou 730030,China;Key Laboratory of Bone and Joint Diseases of Gansu Province,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院骨科,兰州730030 [2]甘肃省骨关节疾病研究重点实验室,兰州730030

出　　处：《中华创伤骨科杂志》2025年第2期143-149,共7页Chinese Journal of Orthopaedic Trauma

基　　金：甘肃省卫生健康行业科研计划项目(GSWSKY2023-23)

摘　　要：目的比较关节镜下自体骨软骨移植术(AOT)与肩胛下肌强化缝合术(ASA)治疗复发性肩关节前脱位合并肩胛盂骨性损伤<20%的疗效。方法回顾性分析2022年1月至2023年1月行关节镜下AOT和ASA治疗的42例复发性肩关节前脱位合并肩胛盂骨性损伤<20%的患者资料。男30例,女12例;年龄(32.2±15.2)岁;左肩12例,右肩30例。根据手术方式不同将患者分为2组:AOT组15例(采用AOT治疗),ASA组27例(采用ASA治疗)。比较两组患者末次随访时的Rowe评分、美国肩肘外科协会评分(ASES)、疼痛视觉模拟评分(VAS)及肩关节活动度,并各自与术前进行比较。记录两组患者并发症发生情况。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。42例患者术后获(17.2±5.9)个月随访。末次随访时ASA组和AOT组患者Rowe评分分别为(97.0±4.4)、(98.3±2.4)分,ASES评分分别为(97.9±5.2)、(99.1±3.7)分,VAS评分分别为0(0,0)、0(0,1)分,两组间比较差异均无统计学意义(P>0.05);两组患者以上项目均各自较术前显著改善,差异均有统计学意义(P<0.05)。末次随访时ASA组和AOT组患者肩关节外展分别为169.2°±3.0°、168.3°±3.1°,前屈分别为171.9°±4.0°、173.3°±4.1°,两组间比较差异均无统计学意义(P>0.05);AOT组外展90°外旋为67.3°±3.2°,显著优于ASA组64.4°±3.5°,差异有统计学意义(P<0.05);两组患者以上项目均各自较术前显著改善,差异均有统计学意义(P<0.05)。所有患者随访期间未出现感染、骨关节炎等。术后ASA组患者中有1例出现肩关节再脱位,有6例出现肩关节疼痛,AOT组患者无患者出现肩关节再脱位或肩关节疼痛,两组间比较差异无统计学意义(P>0.05)。结论AOT与ASA治疗复发性肩关节前脱位合并肩胛盂骨性损伤<20%的患者时,均能改善患者肩关节功能,但AOT在外展90°外旋方面优于ASA。ObjectiveTo compare the arthroscopic autologous osteochondral transfer(AOT)and arthroscopic subscapularis augmentation(ASA)in the treatment of recurrent anterior shoulder dislocation complicated with scapular glenoid bone injury less than 20%.MethodsA retrospective analysis was conducted of the clinical data of 42 patients who had been treated at Department of Orthopaedics,The Second Hospital of Lanzhou University for recurrent anterior shoulder dislocation complicated with scapular glenoid bone injury less than 20%from January 2022 to January 2023.There were 30 males and 12 females,with an age of(32.2±15.2)years.Altogether 12 left shoulders and 30 right shoulders were affected.The patients were divided into 2 groups according to their surgical methods:an AOT group in which 15 cases were treated with AOT and an ASA group in which 27 cases treated with ASA.The Rowe score,American Shoulder and Elbow Surgeons(ASES)score,visual analogue scale(VAS),and shoulder range of motion were compared between groups at the last follow-up.All the above indexes were compared between pre-surgery and post-surgery in each group.The incidence of complications in the 2 groups was recorded.ResultsThere were no statistically significant differences in the preoperative general data between the 2 groups,indicating comparability(P>0.05).A total of 42 patients were followed up for(17.2±5.9)months after surgery.At the last follow-up,in the ASA group and the AOT group respectively,the Rowe score was(97.0±4.4)points and(98.3±2.4)points,the ASES score(97.9±5.2)points and(99.1±3.7)points,and the VAS score 0(0,0)point and 0(0,1)point,showing no significant difference between the 2 groups(P>0.05).The above items in the 2 groups were significantly improved compared with those before surgery(P<0.05).At the last follow-up,in ASA group and AOT group respectively,shoulder abduction was 169.2°±3.0°and 168.3°±3.1°,and flexion 171.9°±4.0°and 173.3°±4.1°,showing no significant difference between the 2 groups(P>0.05);the abduction 90°exter

关 键 词：肩关节疼痛 肩胛盂 肩关节活动度 关节镜下 肩胛下肌 末次随访 缝合术 肩关节外展 

分 类 号：R687.3[医药卫生—骨科学]