改良Boytchev法治疗复发性肩关节前脱位

目的探讨改良Boylchev术式治疗复发性肩关节前脱位的临床效果。方法采用改良Boytehev法治疗肩关节复发性前脱位18例。将喙肱肌、肱二头肌短头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：结果经10个月～4．5年随访,全部骨性愈合,1例出现肌皮神经牵拉症状,1例出现肩关节半脱位,外旋受限〉10°,疗效评价参照邓建龙等标准：优12例,良5例,差1例,优良率为94．4％.结论改良Boytchev法治疗复发性肩关节前脱位术式简单,疗效满意.     

关节镜下手术治疗肩关节习惯性前脱位

<正>2008年6月~2011年12月,我科在关节镜下手术治疗21例肩关节习惯性前脱位患者,效果满意,现报道如下。1材料与方法1.1病例资料本组21例,男14例,女7例,年龄16~63岁。左肩7例,右肩14例。损伤原因:投掷伤12肩,暴力摔伤6肩,高处坠落伤3肩。初次脱位后均行过手法复位,其中11例患肢首次脱位后未行固定,10例患肢行绷带悬吊固定1~3周,继而习惯性脱位发生,脱     

肩关节镜下行Bankart术治疗复发性肩关节前脱位

目的 探讨肩关节镜下Bankart术治疗复发性肩关节前脱位的适应症、手术要点和疗效。方法 对我科2007年1月至2009年7月,15例复发性肩关节前脱位的临床资料进行回顾性分析。15例均为肩关节单方向不稳定,左侧4例,右侧11例,术前脱位次数为2-30次,平均为11.7次。所有患者均采用锚钉进行关节镜下Bankart术,术后采用Constant-Murley法进行评分。结果 术后随访10-24个月,平均12.5个月,所有患者均未出现切口感染及关节腔积血等并发症。终末随访时平均Constant-Murley评分较术前明显改善（术前79.3±4.0对术后95.0±2.2,p<0.01）。终末随访时所有病例均未发生再脱位,术后无残存恐惧试验阳性。结论 关节镜下Bankart术是治疗复发性肩关节前脱位的有效方法之一。     

Modified Boytchev procedure for the treatment of recurrent anterior dislocation of the shoulder

From January 1990 to December 1998, 48 patients with 50 recurrent anterior dislocations of the shoulder were treated using a modified Boytchev procedure. The age of the patients varied from 18 to 35 years (average 24.7 years). The follow-up period was in average 88 (26-132) months. Six patients were lost in follow-up. Forty-two shoulders showed excellent results. There was one traction injury of the musculocutaneous nerve and one patient with immediate recurrence of the dislocation. Superficial wound infection occurred in five cases, all of which were controlled by antibiotics.     

改良关节镜双袢法Latarjet手术治疗癫痫患者复发性肩关节前脱位的疗效观察

目的研究改良关节镜双袢法Latarjet手术治疗癫痫患者伴复发性肩关节前脱位的临床疗效。 方法自2014年10月至2016年10月,共有9例伴发严重骨缺损的肩关节前脱位癫痫患者在深圳大学第一附属医院接受了改良关节镜双袢法Latarjet手术,患者平均年龄为（26.3±3.1）岁,术前均进行超过半年的抗癫痫治疗,术后继续进行抗癫痫治疗1年。术后立刻行CT检查观察骨块位置,分别于术后3、6、12、24个月随访行CT检查观察骨块吸收、愈合情况;并记录患者的美国肩与肘协会评分系统（American shoulder and elbow surgeon’form,ASES）评分、Rowe评分以及Walch-Duplay评分并进行肩关节功能评估。 结果共8例患者得到全程随访,平均随访（20.1±4.2）个月,3例患者术后再发癫痫（未按时服药）,分别为术后2、6、8个月,其中1例（术后6个月癫痫复发）失访,其余2例复发者CT显示骨块明显移位,随后经保守治疗后再次愈合。全部随访患者骨块愈合良好,6例恢复对抗运动,2例恢复正常生活,无肩关节不稳感,CT检查显示移植骨块最终塑形差异较大,其中4例吸收5%~75%,3例较原始状态面积扩大,1例无变化。术前及末次随访时平均ASES评分为（76.75±7.41）分和（94.68±5.02）分（P<0.05）,Rowe评分为（43.75±5.82）分和（93.13±5.30）分（P<0.05）,Walch-Duplay评分为（76.13±6.98）分和（93.00±2.00）分（P<0.05）。 结论改良关节镜双袢法Latarjet技术对于癫痫患者合并肩关节前脱位具有良好的短期临床疗效,且复发后有再次愈合的可能。但更应注意癫痫患者的术后病情控制,尽可能防止癫痫再发作导致手术失败,肩关节复发脱位。     

Twelve years' experience of the mini-Bankart repair for recurrent anterior dislocation of the shoulder

Stabilization for recurrent anterior shoulder dislocation can be achieved through either an open or arthroscopic approach. The former tends to have a lower recurrence rate but longer rehabilitation.The technique of mini-Bankart repair has been used at this establishment since 1996. We retrospectively reviewed the patients that had undergone this procedure. We describe our experience of the mini-Bankart procedure and the results in 24 patients with a mean follow-up of 56 months (range, 12-144 months).The technique is a direct mini-approach to the shoulder joint, preserving the inferior portion of subscapularis. Where present, a Bankart lesion is repaired with two GII Mitek anchors (Ethicon) and the capsule reefed. There were no incidences of repeat anterior dislocation, and the average time period taken to return to work was 8.8 weeks. We recommend this technique due to its low recurrence rate and satisfactory return to normal function.     

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.     

肩关节镜治疗复发性肩关节前脱位

目的 对关节镜治疗复发性肩关节前脱位的疗效进行评价.方法 2001年1月至2006年3月关节镜治疗复发性肩关节前脱位患者52例,其中44例获得随访,随访时间12～54个月,平均26个月.对获得随访的44例患者的临床资料进行回顾性研究.采用美国加州洛杉矶大学肩关节评分系统(UCLA)、肩关节简明测试(SST)、Dawson评分对术后效果进行评价.采用Dawson评分对患者年龄、是否存在松弛、术前脱位频率、复位情况和病程长短等因素对术后疗效的影响进行评价.结果 获得随访的44位患者的脱位复发率为4.5%.术后UCLA、SST、Dawson评分与术前比较差异具有统计学意义,肩关节镜治疗术后优良率在91%以上.患者年龄、病程长短、术前脱位频率、是否伴有关节松弛、复位方法对治疗效果无明显影响.结论 关节镜治疗复发性肩关节前脱位手术效果较好,术后肩关节功能改善明显.     

改良Kocher复位法整复肩关节脱位

肩关节脱位在成人全身关节中最常见的部位之一,约占四肢大关节脱位的40％以上,其中以创伤性前脱位最为多见,其治疗原则是尽早复位,临床上若治疗不当,容易发生复位失败或日后再次脱位。复位方法很多,如悬吊复位法（Stimson法）,足蹬复位法（Hippocratic法）、Kocher复位法及切开复位法。自2003年5月至2007年6月,作者对Kocher复位法加以改进,助手立于患者背后,双手自伤侧腋下紧握于患肩下作对抗牵引,术者立于患者前方,左手握住患肢腕部,右手握住患肢肘部下压,取得了满意疗效,报告如下。     

肩关节前脱位复位

2006年1月～2007年6月,笔者采用蹬肩外展牵引复位方法治疗新鲜肩关节前脱位25例,与牵引推拿法、Hippocrateri法等比较,优点明显。     

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。     

复发性肩关节前方不稳定的诊断与治疗

复发性肩关节前方不稳定是我们在临床工作中经常能碰到的一类问题。目前,该病的发病机制、诊断方法以及治疗手段均有了极大的进展。基础研究方面,从明确盂肱韧带在肩关节不稳定发病中的重要意义发展到目前认为肩关节的稳定是由肩关节周围的主动、被动稳定结构的综合作用的结果。诊断方面,在传统的病史、查体及X线片等方法的基础上进一步引入了MRI、麻醉下查体以及关节镜检查等新的方法。关于该病的治疗,一方面切开手术治疗尤其是Bankart修补术已日益成熟并成为治疗的金标准;另一方面,关节镜下修补术由于其突出的优势在近来获得了迅速的发展,并逐步取得了与切开手术近似的效果。     

复发性肩关节前脱位与关节内继发损伤的相关性研究

目的通过分析肩关节前脱位次数、病程与关节内继发损伤的关系,探讨复发性肩关节前脱位对关节内继发损伤的影响。方法回顾分析2005年1月-2009年6月关节镜下应用缝合锚钉行Bankart重建术治疗的59例复发性肩关节前脱位患者临床资料。男48例,女11例;年龄15～42岁,平均27.6岁。初次脱位原因:接触性体育运动21例,非接触性体育运动13例,日常活动11例,外伤14例。术前脱位3～32次,平均10.6次。初次脱位至手术时间为11个月～12年,中位时间5.9年。患者恐惧试验及复位试验均呈阳性。术前美国加州大学洛杉矶分校(UCLA)肩关节功能评分为(22.3±2.4)分,Constant-Murley评分为(73.1±5.8)分。关节镜下观察关节内继发损伤情况,并进行统计分析。结果术后患者切口均Ⅰ期愈合。患者均获随访,随访时间16～58个月,平均37.3个月。末次随访时,UCLA肩关节功能评分为(34.6±1.7)分,Constant-Murley评分为(86.7±6.1)分,与术前比较差异均有统计学意义(P<0.05)。术前关节脱位次数和关节软骨损伤的严重程度成正相关(rs=0.345,P=0.007),和Hill-Sachs损伤严重程度成正相关(rs=0.708,P=0.000);首次脱位至手术时间和关节软骨损伤严重程度成正相关(rs=0.498,P=0.000),与Hill-Sachs损伤严重程度无相关性(rs=0.021,P=0.874)。结论复发性肩关节前脱位早期行Bankart重建有利于肩关节功能恢复,避免或延缓关节内继发损伤的发生和发展。     

Rare anterior shoulder dislocation in a toddler

Traumatic anterior shoulder dislocation in toddlers and pediatric patients is a very rare injury pattern. The treatment and the recurrence rate are mostly extrapolated from adult and adolescent data. A 2-year-old toddler is presented with a first-time traumatic shoulder dislocation caused by a pull on the abducted arm. The treatment included a gentle closed reduction performing the Milch maneuver and a short-sling immobilization. The 2.5-year-follow-up demonstrated a stable shoulder with free range of motion while still having a Hill-Sachs-lesion. Shoulder dislocation in toddlers maybe addressed less aggressively after closed reduction than in adults due to an unknown recurrence rate. The authors have received nothing of value.     

Boytchev procedure for the treatment of anterior shoulder instability

Most of the operative techniques described for the treatment of recurrent anterior dislocations or subluxations of the shoulder have two distinct disadvantages: the need to immobilize the arm for several weeks and loss of external rotation. These disadvantages provided an incentive for conducting a clinical evaluation of an operation originally described by Boytchev and modified by the author. In this procedure, the conjoined tendons of the coracobrachialis and the short head of the biceps with the detached tip of the coracoid process are rerouted posterior to the subscapularis muscle and reattached to the coracoid process, providing a dynamic muscular sling immediately anteroinferior to the glenohumeral joint, especially when the arm is in a vulnerable position of abduction and external rotation. A total of 26 repairs with a minimal follow-up period of two years were reviewed. There were 22 men and four women with an average age of 22 years. The results were satisfactory in all patients. Loss of external rotation of less than 15 degrees was noted in eight patients. There were no redislocations. This procedure provides immediate stability to the shoulder allowing range of motion exercises to begin from the first postoperative day.     

The role of TNXB single‐nucleotide polymorphisms in recurrent shoulder dislocation

Tenascin‐X (TNX) is an extra‐cellular matrix glycoprotein associated with collagen fibril deposition. Recent reports have linked truncated TNX mutations (TNXB) to generalized joint hypermobility and most importantly recurrent joint dislocation. In the present study, we investigated whether there is an association between joint dislocation recurrence rate and the frequency of TNXB single‐nucleotide polymorphisms (SNPs). Seventy‐eight patients treated for post‐traumatic shoulder instability and 82 healthy controls were genotyped for selected TNXB SNP using TaqMan® Genotyping Assays. At a mean follow‐up of 24 months recurrence rate and clinical outcomes were evaluated using the Constant and Murley, Rowe, and DASH scores. The association between genotypes and joint dislocation was tested using the dominant, recessive and additive models, and the model‐free approach. Genotype distribution of the examined SNPs did not significantly deviate from the Hardy–Weinberg equilibrium (HWE) neither in patients nor in the controls. Moreover, there was no significant difference in genotype and allele distribution between patients and controls. Finally, no difference in genotype frequency was detected between patients who experienced a re‐dislocation after the initial surgery and patients who did not sustain a re‐dislocation. The SNPs investigated in this study have no clinically relevant influence on TNXB gene expression and/or TNX function. Therefore, these SNPs could not be used for predicting individual risk of recurrent shoulder dislocation. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 295–299, 2013     

Long-term results of the Boytchev procedure for the treatment of recurrent dislocation of the shoulder

The authors present the long-term results obtained with the Boytchev technique in the treatment of recurrent anterior dislocation of the shoulder. Recurrence, clinical outcome and functional limitations were evaluated. A total of 27 shoulders in 25 patients were studied. The average follow-up period was 13.3 years. There were no immediate neurovascular complications and no residual pain. The average recovery time was 4.3 months. Dislocation recurred in five shoulders (18%) and 18.5% of the patients were left with restricted mobility. All patients resumed their previous employment although sporting capacity recovered to pre-injury levels in only 9 of 15 patients. The results were classified as good in 18.5% and as excellent in 40.7% of the patients, but the remaining 40.7% had a fair or poor result. In conclusion, the recurrence rate is high and nearly 20% of the patients are left with limited shoulder mobility. Furthermore, although all the patients were able to return to their job, only 60% of those engaged in sports regained their previous level. This technique, although attractive, is better avoided.     

肩关节后脱位的诊断与治疗

目的 探讨肩关节后脱位相关诊断方法的意义和治疗效果。方法 对5例漏珍的肩关节后脱闰进行创伤系列X线检查和CT扫描检查。根据伤后延误时间、临床症状和影像学检查结果选择治疗方法。3例行早期闭合复位,2例陈旧脱位中,1例行切开复位内固定,1例放弃复位。结果 CT、MRI和肩关节侧位、腋窝位、Velpeau腋窝位X线片分别显示5例、1例、2例、5例肩关节后脱位;CT和腋位X线检查同时显示伴随骨折。随访2－5年,闭合复位者UCLA评分32－35分;切开复位者UCLA评分14分;未予复位者UCLA评分22分。结论 临床上对该症认识不足是造成漏诊的主要原因,早期闭合复位可取得良好功能恢复。     

悬吊牵引复位法治疗首次肩关节前脱位

2014 年6 月～2018 年12 月,我科采用悬吊牵引复位法治疗60 例首次肩关节前脱位患者,疗效满意,报道如下. 1 材料与方法 1. 1 病例资料 本组60 例,男24 例,女36例,年龄54 ～88 岁.均确诊为首次肩关节前脱位.