改良Boytchev法治疗习惯性肩关节前脱位15例

目的：介绍改良断hev法治疗习惯性肩关节前脱位的方法及疗效。方法：1976年3月-2005年6月收住15例习惯性肩关节前脱位患者，采用喙肱肌和肱二头肌短头形成的联合腱连同喙突尖在肩胛下肌下穿过再将喙突尖原位固定。结果：15例患者临床平均4年5个月随访无1例再脱位，术后所有患者关节功能评价良好，优良率为100％。结论：80ytchev手术是治疗复发性肩关节前脱位简单、有效的方法。     

Boytchev方法治疗复发性肩关节前脱位

目的：介绍Boytchev术式治疗复发性肩关节前脱位的方法及疗效。方法：1997年5月以来应用该术式治疗8例复发性肩关节前脱位患者，将喙肱肌、肱二头肌短头及胸小肌垂直纤维形成的联合腱连同喙突尖在肩胛下肌下穿过再将喙突尖原位固定。术后肩部固定3周后行功能锻炼。结果：临床平均20个月随访无1例再脱位，术后所有患者关节功能评价良好，优良率为100％。结论：Boytchev手术是治疗复发性肩关节前脱位简单、有效的方法。     

联合腱悬吊治疗肩关节前脱位

作者采用联合腱悬吊手术习惯性肩关节前脱位。将喙肽肌和肱二头肌短头形成的联合腱边同喙突尖在肩胛下肌下穿过再将喙突尖原位固定。自１９８７年２月－１９２２年１２月共收治３０例，经临床平均３年以上随访访无１例再复发脱位，并保留良好的上臂外旋外展功能，术后所有肩关节功能评价良好。     

小切口联合术式治疗复发性肩关节前下脱位

[目的]观察经小切口改良Bristow手术联合锚钉修复前关节囊-盂唇治疗复发性肩关节前下脱位的临床疗效。[方法]自2011年1月~2014年4月治疗复发性肩关节前下脱位13例。取喙突下约5 cm纵行切口,暴露喙突并予以截骨,在肩胛下肌上缘将喙突骨块连带联合腱用1枚空心钉固定于肩胛颈上下中线稍下方距关节骨性盂缘0.5cm处。另外加用2枚铆钉固定在肩胛盂前方,行前方关节囊-盂唇的修补。术后采用Rowe肩关节修正评分进行随访,平均随访16个月(9~48个月)。[结果]手术时间平均55 min(50~75 min),未发生严重并发症。随访期间所有患者均无再脱位,末次随访时Rowe肩关节修正评分平均91.5分,结果全为优。[结论]小切口改良Bristow手术联合锚钉修复关节囊手术创伤小,临床疗效确切。     

肩关节综合手术治疗肩关节复发性前脱位的疗效分析

目的 分析应用肩关节综合手术治疗肩关节复发性前脱位的疗效。方法 采用肩关节综合手术（关节盂前下缘骨性阻挡、喙突尖端骨块带联合肌腱悬吊固定于锁骨并紧缩缝合关节囊）治疗肩关节复发性前脱位28例。结果 28例术前、术后1年肩关节ASES评分为68.5分和83.7分,差异具有统计学意义（P〈0.05）;Rowe评分为30.9分和74.3分,差异具有统计学意义（P〈0.05）。3例术后出现再发脱位,其中1例因外伤所致,2例术后阻挡骨块与关节盂骨质未愈合而致再发脱位。结论 应用肩关节综合手术是治疗复发性肩关节前脱位合理、有效的治疗方法。     

Torg氏改良的Bristow手术治疗肩关节复发性前脱位

目的介绍治疗肩关节复发性前脱位的Torg氏改良的Bristow术式,评价其临床效果。方法采用Torg改良Bristow方法治疗肩关节复发性前脱位31例,平均年龄22.3岁。结果术后随访1～6年(平均44个月),1例手术后2年时发生1次再脱位,3例术后发生过一次或多次的半脱位,8例患者诉肩关节运动时或运动后有轻度疼痛,1例患者因内固定螺钉处疼痛和弹响需去除螺钉。肩关节术后外旋受限10°～15°5例,外展受限10°2例,其余患者肩关节活动范围恢复至术前。其中21例运动员和教练中,有3名运动员虽无再脱位发生,但未能恢复到伤前训练水平,余均达到伤前训练水平。结论Torg改良的Bristow手术方法治疗肩关节多发性前脱位再脱位发生率低,术后肩关节活动受限程度轻,运动员患者恢复伤前训练水平的比例较高,且手术损伤小、步骤简单、易于实施。     

足蹬外旋复位法治疗肩关节前脱位的病例对照研究

目的：介绍足蹬复位法（Hennipen）外旋治疗肩关节前脱位的特点及其临床疗效。方法：2007年3月至2010年3月采用Hennipen外旋法治疗肩关节前脱位28例（Hennipen组）,男17例,女11例;年龄21-72岁,平均（39．2＋5．1）岁;其中喙突下脱位8例,盂下脱位16例,锁骨下脱位4例。同期采用足蹬法复位法治疗肩关节前脱位44例（Hippocratic组）,男32例,女12例;年龄15-68岁,平均（36．8＋3．4）岁;其中喙突下脱位12例,盂下脱位29例,锁骨下脱位3例。所有患者均根据临床表现和肩关节X线片确诊,手法复位后行搭肩位肘胸绷带固定3～4周。比较两组患者复位过程、并发症及功能恢复情况（采用UCLA肩关节功能评分标准）。结果：Hippocratic组复位操作在2-5min完成[平均（3．9＋1．2）rain],其中32例接受静脉麻醉;Hennipen组复位操作在0．5-2rain完成[平均（1．3±0．7）min],3例患者需在麻醉下复位;两组复位时间差异有统计学意义（P〈0．05）。Hippocratic组1例老年患者复位过程中发生肱骨大结节撕脱骨折,1例发生肋骨骨折;Hennipen组无明显并发症发生。复位3-4周后随访,Hippocratic、Hennipen组患者肩关节UCIA评分分别为（34．2±2．1）分和（33．8±1．6）分,差异无统计学意义（P〉0．05）。结论：足蹬法复位法和Hennipen外旋法治疗肩美节前脱位均能获得良好的疗效．但HenniDen外旋法操作简单．并发症少．尤其适干急诊寅位操作。     

改良小切口Latarjet术治疗复发性肩关节前脱位

目的探讨改良小切口Latarjet术治疗肩关节复发性前脱位的临床疗效。方法对2012年1月至2014年12月我院收治的14例合并明显肩盂骨缺损的复发性肩关节前脱位行改良小切口Latarjet手术患者病例资料进行回顾性研究,其中男11例,女3例;左肩4例,右肩10例;年龄19~43岁,平均25.1岁。术后通过影像学报告、Constant-Murley评分和视觉模拟评分(visual analogue scale,VAS)对临床结果进行评估。结果 14例患者术后获得了12~36个月随访,平均22.8个月;切口长度4.5~6.5cm,平均4.9cm;喙突骨块与肩盂平齐率92.86%,在2~5点位置为100%。末次随访Constant-Murley评分87~100分,平均94.7分;VAS评分0.5~2.0分,平均1.3分;无患者复发肩关节脱位或半脱位,无骨块骨折,无内固定物松动、脱落等并发症出现。结论改良小切口Latarjet术治疗复发性肩关节前脱位伴明显肩盂骨性缺损的患者临床疗效良好,具有创伤小、疗效好、并发症少等优点。     

切开复位带线锚钉内固定治疗Eyres ⅡB型肩胛骨喙突骨折3例报道并文献复习

目的 观察切开复位带线锚钉内固定治疗3例Eyres ⅡB型肩胛骨喙突骨折的临床疗效,并进行文献复习。方法回顾性分析自2019-01—2021-06采用切开复位带线锚钉内固定治疗的3例Eyres ⅡB型肩胛骨喙突骨折,采用三角肌与胸大肌间隙入路,切口中点位于肩胛骨喙突上,显露喙突中部骨折,因肱二头肌短头腱与喙肱肌牵拉,骨折块向外下移位明显,与肱二头肌短头腱与喙肱肌相连,喙锁韧带完整,清理骨折端,直视下复位骨折,骨折对位、对线满意。在游离骨块上钻孔,用1枚直径3.5 mm钛质带线锚钉内固定。结果 3例术后均获得至少10个月随访,无切口感染、切口愈合不佳、神经血管损伤、骨折不愈合、内固定松动断裂等并发症发生。术后3个月复查X线片与CT显示骨折愈合良好,双侧肩关节对称、外观正常,肩关节活动度恢复满意。术后10个月时肩关节疼痛VAS评分为0、0、1分,肩关节功能Herscovici评分为15、14、14分。结论 切开复位带线锚钉内固定手术治疗EyresⅡB型肩胛骨喙突骨折的疗效满意,骨折复位固定可靠,可确保骨折愈合良好与术后肩关节活动度恢复正常。     

关节镜下改良弹性固定Latarjet术治疗一例慢性锁定性肩关节前脱位

目的总结关节镜下改良弹性固定Latarjet术治疗1例慢性锁定性肩关节前脱位的经验。方法 2016年7月收治1例因摔伤致右肩疼痛、畸形、活动受限8周的49岁男性患者。伤后曾于外院行肩关节复位,未成功。术前美国肩肘外科协会(ASES)评分22分,肩关节功能Constant-Murley评分37分,疼痛视觉模拟评分(VAS)8分。影像学检查示右肩关节锁定性前脱位、肩袖损伤、Hill-Sachs损伤。术前诊断右肩关节慢性锁定性前脱位伴肩袖损伤。全关节镜下彻底松解关节盂、肱骨头、肩胛下肌腱周围及肱三头肌止点软组织,关节复位后以改良双袢法弹性固定Latarjet术。结果术后切口Ⅰ期愈合,无重要血管及神经损伤等并发症发生。患者获随访24个月。影像学复查示盂肱关节恢复正常对位关系,无脱位复发。右肩关节功能恢复正常,24个月时ASES评分及Constant-Murley评分均为94分。结论关节镜下改良弹性固定Latarjet术治疗慢性锁定性肩关节前脱位疗效满意。     

Bristow surgical treatment of shoulder dislocation

14 shoulders with recurrent anterior dislocation were treated with a modified Bristow procedure and had a 38 to 66 months follow up after surgery. Postoperatively no patient had recurrent anterior dislocation. 4 patients had an average loss of external rotation of 10-15 degrees, one patient had a non-union of the transplanted coracoid. None of the patients was disappointed by the results.     

Pseudarthrose du processus coracoïde après luxation antérieure de l’épaule

Purpose of the studyThe aim of this study is to present an unusual lesion combining instability of the shoulder with a fracture of the coracoid process.Material and methodsThe authors have treated one case of recurrent anterior dislocation of the shoulder associated with pseudarthrosis of the coracoid process. The shoulder was stabilised by surgery using the Latarjet procedure.DiscussionThe association of an anterior dislocation of the shoulder and pseudarthrosis of the coracoid process is very unusual. It is often unrecognized because of poor knowledge of this lesion or poor quality of the radiographs performed in the emergency room. The most likely mecanism is a direct impact of the humeral head against the coracoid process during the dislocation. The diagnosis requires good quality radiographs. When the shoulder is painful or unstable, surgical treatment is performed and the Latarjet procedure takes care of both the pseudarthrosis and the instability of the shoulder.     

The Boytchev procedure for recurrent anterior dislocation of the shoulder. A controversial technique

In the Boytchev technique the conjoined tendons of the coracobrachialis and short head of the biceps, together with the tendon of the pectoralis minor and the detached tip of the coracoid process are rerouted behind the subscapularis muscle, and reattached to the coracoid process with a screw. During a 10-year period 37 patients with recurrent anterior dislocation underwent a Boytchev procedure. Twenty-six patients (with 27 shoulders) were available to follow-up. The results of this retrospective study were disappointing, as the overall redislocation rate was 44%. The opinions of other authors were found to be extremely divergent.     

Recurrent shoulder dislocations secondary to coracoid process fracture: a case report

Coracoid process fracture is easily missed in recurrent anterior shoulder dislocation. We report one such case in a 48-year-old man. Radiology revealed the Bankart lesion and the Hill-Sachs lesion only; the coracoid process fracture was discovered intra-operatively. The anatomy of the shoulder was restored by fixing the fragment to its scapular remnant with a 4-mm cannulated cancellous screw. The tip and the proximal fragment were reamed before inserting the screw. This fragment was routed with attached short head of biceps and coracobrachialis through the lower one third of the subscapularis, before homing it and fixing it to the proximal coracoid fragment. This extraarticular repair resulted in less stiffness than any intra-articular procedure. At the 2-year follow-up, the patient had had no further shoulder dislocation.     

The treatment of recurrent anterior shoulder dislocation by the modified Bristow-Helfet procedure

South African orthopaedic surgeons have been in the forefront of the development of reconstructive procedures performed for recurrent anterior shoulder dislocation. In addition to the Johannesburg stapling operation described by G. T. du Toit and D. Roux, Professor A. Helfet of Cape Town was the first to describe the coracoid transplantation operation in 1958. A modified form of this operation was performed on 31 patients between August 1975 and February 1981. Patients were followed up for a mean period of 38 months, and no recurrences were encountered in patients who had had true involuntary recurrent subluxation or dislocation. The operative technique is described in detail as it is considered that adequate exposure and accurate placement of the coracoid process are very important factors in obtaining a satisfactory result and in the prevention of complications. It has been postulated that this operation, which does not attempt to shorten the capsular structures or subscapularis tendon, affords a superior result in respect of patients who participate in throwing sports. It has been noted that patients who play cricket, baseball and basketball have encountered problems in regaining their ability to throw overhand after having had operations such as the Putti-Platt procedure, which entails intentional shortening of the capsular structures and subscapularis tendon.     

Recurrent shoulder dislocation and screw failure after the Bristow-Latarjet procedure. A case report

A 22-year-old male was operated on with coracoid transfer according to the Bristow-Latarjet procedure because of recurrent anterior dislocation of his right shoulder. Nine months later the patient sustained a repeat shoulder dislocation after moderate trauma. The screw was radiographically found to be bent. Subscapularis shortening according to Putti-Platt was performed. No repeated episodes of dislocation and no instability has been experienced by the patient since then. However, one year later, he awoke with pain dorsal to the humeroscapular joint. Radiographs showed the screw to be broken. The proximal part of the screw was located underneath the humeroscapular joint and was removed. After this, the patient was free of pain and returned to work as a carpenter.     

Modified Boytchev procedure for treatment of recurrent anterior dislocation of shoulder

Background:

More than 200 different operations have been described for the treatment of recurrent anterior dislocation of shoulder. The Modified Boytchev procedure employs rerouting of the detached tip of coracoid process with its attached conjoined tendon (short head of biceps and coracobrachialis) deep to subscapularis and reattaches to its anatomical location. We conducted a study on evaluation of long-term effect of modified Boytchev procedure and to compare our results with other studies published in literature.

Materials and Methods:

Since June 2002, modified Boytchev procedure was performed on 48 patients, who presented with recurrent anterior dislocation. 45 were men and 3 were women and were in the age group of 18-40 years (mean 27.83±4.95 years). Forty patients were affected on the dominant side and rest on the non-dominant side. The mean number of dislocations in these patients was 18.22±12.08. The mean followup period was 58.13±19.06 months (range 18-96 months). The patients were evaluated by visual analogue score, modified American Shoulder and Elbow Surgeon''s Score (ASES), and Single Assessment Numeric Evaluation (SANE) score at the last followup.

Results:

All the patients regained almost preoperative range of forward flexion at the last followup. In the preoperative period the mean external rotation deficit at 0° and at 90° of abduction was 13.22°±5.16° and 18.06°±6.50°, respectively. At the last followup, the mean external rotation deficit at 0° and at 90° of abduction was 8.06°±2.47° and 8.95°±2.07°, respectively. This improvement in external rotation deficit was statistically significant (P<.05). Preoperative scores were compared with the most recent followup scores for all variables with use of a paired t test. All patients had significant improvement in visual analogue score, modified American Shoulder and Elbow Surgeon''s Score (ASES), and Single Assessment Numeric Evaluation (SANE) score at the last followup. Four of the patients developed superficial infection which got resolved after treating with antibiotics, and two of the patients developed transient musculocutaneous nerve paresis. There was no radiological evidence of loosening and migration of coracoid screw or any glenohumeral arthritis on subsequent followup of skiagrams in any of our patients.

Conclusion:

Modified Boytchev procedure is an efficacious and technically simple procedure to treat recurrent anterior dislocation of shoulder.     

The Modified Bristow Procedure for Recurrent Anterior Dislocation of the Shoulder: Results and Complications

Seventeen out of eighteen patients, who underwent the modified Bristow operation for anterior recurrent dislocation of the shoulder, were followed up after a mean observation time of 52 months. Fourteen patients were satisfied with the result. There were no redislocations. The principal limitation in range of motion was loss of some external rotation. Eight patients had non-union between the bone transplant and the glenoid rim, and four of these had complications related to the screw. Two had loosenings and two had fractures of the screw. Non-union without screw complications appeared not to influence the end result. The reasons for the complications seem to be technical problems concerning fixation and bone union of the coracoid process.     

A modified Bristow-Helfet-May procedure for recurrent dislocation and subluxation of the shoulder. Report of two hundred and twelve cases

A modified Bristow-Helfet-May procedure was performed for recurrent dislocation or subluxation of the glenohumeral joint in 207 patients (212 shoulders), whose average age at the time of surgery was 20.3 years (range, fourteen to forty-seven years). The procedure was modified by directing the coracoid segment and conjoined tendon over the superior border rather than through the substance of the subscapularis tendon and muscle. The indications were either documented recurrent anterior dislocation of the glenohumeral joint or subluxation with instability as demonstrated on examination with the patient under anesthesia. The procedure was evaluated on the basis of the rate of recurrence of dislocation and subluxation, postoperative complications, the patients' subjective evaluation, and the effect of the procedure on the motion of the glenohumeral joint and the strength of the muscles of the shoulder as related to overhead throwing. Eight (3.8 per cent) of the shoulders redislocated and ten (4.7 per cent) had one or more subjective episodes of subluxation after the procedure. Complications included postoperative infection in two patients and problems with the screw that required its removal in ten. One hundred and thirty-one (62 per cent) of the patients responded to a questionnaire regarding their subjective evaluation of the results of surgery. Eleven (8 per cent) were unable to perform daily activities that involved overhead work, and forty-five (34 per cent) stated that they still had some degree of discomfort or pain in the shoulder. One hundred and twenty-six patients (96.2 per cent) stated that they were happy with the results of the surgery and would have the procedure again. Thirty patients had Cybex testing of the muscles of the shoulder. Only three (16 per cent) of the nineteen athletes whose dominant arm had been operated on returned to their pre-injury level of throwing. Data obtained with regard to changes in the range of motion and strength of the glenohumeral joint indicate that this loss of throwing ability was not due solely to a loss of glenohumeral motion. It appeared to be also related to a concomitant loss of strength at the extreme of external rotation of the humerus and the initiation of internal rotation of the humerus.