肩关节脱位合并肩袖与Bankart损伤的诊治

目的 探讨关节镜下修复肩关节前脱位合并肩袖与Bankart损伤的疗效.方法 1999年9月至2007年7月收治16例肩关节脱位合并肩袖与Bankart损伤患者,男14例,女2例;左肩6例,右肩10例.交通伤8例,运动伤4例,牵拉伤4例.受伤至手术时间平均4.5个月(1.5～11.0个月).肩关节x线片显示肩盂撕脱骨折3例.16例患者肩关节核磁共振造影显示肩袖与Bankart损伤.关节镜探查发现肩袖于肱骨大结节处撕脱伴肩袖挛缩12例.采用关节镜下松解、缝合锚钉和骨锚钉同定缝合9例;因肩袖挛缩明显,进行关节镜与小切口辅助下肩袖缝合固定术3例;肩衲组织因牵拉松弛抬肩无力,采用等离子刀皱缩和肩袖缝合紧缩术4例.Bankart损伤采用关节镜下可吸收Bankart钉固定3例,钛合金缝合锚钉固定3例,关节镜下直接缝合修补盂唇3例,骨锚钉加会属锚钉固定7例.结果 16例患者术后获平均16.5个月(7～34个月)随访.肩关节稳定,肩外展和上举功能恢复正常12例,术后肩关节外展、抬举活动轻度受限2例,前伸活动疼痛2例.金属锚钉拔出再手术2例.采用美国加州洛杉矶大学UCLA肩关节功能评分:术前平均(21.5±5.5)分;术后平均(32.4±5.6)分,优12例,良4例.结论 肩关节脱位合并肩袖与Bankart损伤核磁共振造影有助于诊断;肩袖挛缩者应进行充分松解,无张力缝合固定有利于肩袖愈合;异体骨锚钉修复肩袖与Bankart损伤,生物固定、费用低廉,具有重要的价值.

Shoulder dislocation combined with rotator cuff injury and Bankart lesion

Objective To explore the feasibility of arthroscopic repair of anterior dislocation of shoulder combined with rotator cuff injury and Bankart lesion. Methods Sixteen cases of shoulder dis-location combined with rotator cuff injury and Bankart lesion were inspected arthroscopically. They were 14 males and 2 females. Six left and 10 right shoulders were affected. There were 8 traffic injuries, 4 sports injuries, and 4 traction injuries. All patients underwent magnetic resonance arthrography (MR.A). The aver-age duration between injury to operation was 4.5 (1.5 to 11.0) months. Arthroscopic inspection revealed 12 cases of rotator cuff tear at the greater tuberosity of humerus combined with rotator cuff contracture. Nine cases had rotator cuff release and fixation with suture anchor or bone anchor. Three cases had mini-open rotator cuff repair because of severe contracture of the rotator cuff. Four cases had plasma shrinkage and tightening suture of the rotator cuff because of rotator cuff laxity. Three cases of Bankart lesion had arthroscopic fixation with bio-absorbable Bankart anchor, 3 cases had titanium suture anchor, and 7 cases had bone anchor. Results All patients were followed up for an average of 16.5(range, 7 to 34) months. Twelve cases restored normal abduction and upright movement. Two cases had slight limitation of extension, and 2 cases had pain in ac-tivity. Two eases had re-operation due to extraction of titanium suture anchor. UCLA ( University of California at Los Angeles) scores were 21.5±5.5 and 32.4±5.6, respectively. Twelve eases were excellent and 4 were good. Conclusions MRA is beneficial for diagnosis of shoulder dislocation combined with rotator cuff injury and Bankart lesion. Severe eontracture of rotator cuff should be released sufficiently and repaired without tension. Allograft bone anchor might achieve biological fixation and low consumption.