肩胛下肌强化缝合术治疗伴有严重盂唇损伤的复发性肩关节脱位

目的:探讨肩胛下肌强化缝合术治疗伴有严重盂唇损伤的复发性肩关节脱位的方法和临床疗效。方法:回顾性分析2019年3月至2020年8月行肩胛下肌强化缝合术(arthroscopic subscapularis augmentation,ASA)治疗伴有严重盂唇损伤的复发性肩关节脱位的患者16例,其中男10例,女6例;年龄18~50(29.06±10.54)岁;左肩4例,右肩12例。在手术前后采用疼痛视觉模拟评分(visual analogue scale,VAS),美国肩肘外科协会(American Shoulder and Elbow Surgeons,ASES)评分及肩关节功能Rowe评分对肩关节功能和稳定性进行评估。结果:16例患者均获随访,时间12~29(18.75±7.26)个月。VAS由术前的(5.25±1.13)分降至末次随访的(1.37±0.65)分;ASES评分由术前的(59.44±9.93)分增加至末次随访的(90.88±4.00)分;肩关节Rowe 评分由术前的(51.56±8.89)分增加至末次随访的(92.19±7.06)分(P<0.05)。随访期间未见肩关节脱位,所有患者术后未出现切口感染、血管神经损伤等临床并发症。结论:肩胛下肌强化缝合术是治疗伴有严重盂唇损伤的复发性肩关节脱位的有效方法,并且患者的外旋功能几乎不受影响。

Arthroscopic subscapularis augmentation for the treatment of recurrent dislocation of shoulder with severe glenoid injury

Objective: To investigate the method and clinical effects of the treatment of recurrent shoulder dislocation with severe glenoid injury by arthroscopic subscapularis augmentation. Methods: From March 2019 to August 2020,16 patients with recurrent dislocation of shoulder with severe glenoid injury underwent arthroscopic subscapularis augmentation,including 10 males and 6 females,aged from 18 to 50 years old with an average of (29.06±10.54) years old,4 cases of left shoulder and 12 cases of right shoulder.Visual analogue scale (VAS),American Shoulder and Elbow Surgeons (ASES) score and Rowe score were used to evaluate shoulder function and stability before and after operation. Results: All the 16 patients were followed up from 12 to 29 months,with an average of (18.75±7.26) months. VAS score decreased from 5.25±1.13 before operation to 1.37±0.65 at the final follow-up;ASES score increased from 59.44±9.93 before surgery to 90.88±4.00 at the final follow-up; Rowe score of shoulder increased from 51.56±8.89 before surgery to 92.19±7.06 at the final follow-up,and the differences were statistically significant (P<0.05). No dislocation was observed during follow-up. No clinical complications such as incision infection,vascular and nerve injury occurred in all patients after operation. Conclusion: Arthroscopic subscapularis augmentation in the treatment of recurrent dislocation of shoulder with severe glenoid injury is satisfactory. It is an effective treatment method of recurrent dislocation of shoulder joint with severe glenoid injury,and external rotation function in patients with almost unaffected.