Torg氏改良的Bristow术式治疗肩关节复发性前脱位

目的:探讨Torg氏改良的Bristow术式治疗复发性肩关节前脱位的方法及疗效。方法:2002年~2006年间于本院行Torg氏改良的Bristow术式治疗复发性肩关节前脱位患者25例,所有病例依据病史、典型的恐惧试验以及至少一次的肩关节前脱位X线片检查得以明确诊断。肩关节前方切口,行喙突-肱二头肌短头、喙肱肌联合腱截骨后,由肩胛下肌上缘下压肩胛下肌,采用钛质空心钉固定肩胛盂颈部中下1/3处。结果:所有病例通过肩关节镜探查,均有典型的Bankart损伤和Hillsach损伤;随访1~5年,再脱位1例,患者主观满意度良好,肩关节不稳定恐惧感均明显改善。rowe评分:优18例(72%)、良6例(24%)、一般1例(4%)、差0例。结论:采用Torg氏改良的Bristow术式治疗肩关节复发性前脱位复发率低,患者满意度高。     

关节镜下Bankart修复治疗训练伤所致慢性肩关节前方不稳

目的观察关节镜下Bankart修复治疗训练伤所致慢性肩关节前方不稳的临床疗效。方法选择21例肩关节前方不稳的患者,关节镜下锚钉修复盂唇损伤,同时修复合并出现的上盂唇前后(SLAP)损伤,较大的Hill-sachs损伤。采用UCLA功能评分标准和SST评分进行疗效的评估,记录术前和终末随访的得分。结果术后患者随访12~45个月,平均随访27个月。SST得分术前为(6.72±2.38)分,术后终末随访评分为(11.24±1.46)分,同术前比较差异有统计学意义(P<0.01)。术前UCLA平均得分为(19.55±5.02)分,术后终末随访评分为(33.19±4.61)分,与术前比较差异有统计学意义(P<0.01)。结论关节镜下Bankart修复治疗训练伤所致肩关节前方不稳疗效满意,可以很好恢复肩关节功能。     

伴关节盂骨质缺损的复发性肩关节前脱位的全关节镜下Bristow-Latarjet术治疗进展

肩关节是人体全身关节中活动度最大的关节,其脱位约占全身关节脱位的40%以上,其中前脱位占绝大部分。随着肩关节前脱位频率增加,肩盂前下盂唇的损伤往往会伴有不同程度的骨质缺损。目前针对复发性肩关节前脱位的关节镜下手术治疗方法主要分为两步:关节内稳定手术(Bankart修复术)和关节外稳定手术(Bristow-Latarjet术)。关节镜下Bankart修复术在过去数十年里已经渐渐成熟且不断被外科医生所掌握,而全关节镜下Bristow-Latarjet术学习曲线陡峭,难度系数大,而且在近几年来仍然在不断地改良。虽然该术式逐步取得了与切开手术近似的疗效,甚至在某些方面已经远远优于切开手术,但仍存在不足之处。本文综述近5年来国内外全关节镜下Bristow-Latarjet术的治疗进展,为后续相关研究提供借鉴。     

关节镜下带线铆钉重建后盂唇治疗肩关节后方不稳定

目的:探讨关节镜下带线铆钉重建后盂唇并选择性缝合肩袖间隙治疗肩关节后方不稳的疗效。方法:2012年9月~2015年3月先后共13例肩后向不稳患者,年龄18~36岁,平均年龄27.9岁,在我院行关节镜下带线铆钉重建后盂唇并选择性缝合肩袖间隙术,获得15~31月随访,平均随访时间22.5月。比较手术前后的UCLA肩关节评分、患肩关节外展位外旋角度来评估疗效。结果:手术效果均满意,UCLA肩关节评分术前与术后差异有统计学意义(由术前26.69±1.032提高到术后33.77±2.127,P=0.000),而肩外展位外旋角度术前与术后差异无统计学意义(P=0.906)。结论:关节镜下带线铆钉重建后盂唇并选择性缝合肩袖间隙治疗肩关节后方不稳对恢复肩关节稳定和功能有效。     

改良小切口Bristow手术治疗习惯性肩关节前下脱位的临床随访观察

目的 介绍改良小切口Bristow手术治疗习惯性肩关节前下脱位方法,并观察其临床疗效. 方法 肩关节复发性前下脱位11例.取肩关节前方约3～5 mm切口,采用"移动窗"技术,暴露喙突并予以截骨,通过肩袖间隙将喙突连带肱二头肌短头固定于肩胛颈前下方.11例术后采用Rowe肩关节修正评分进行临床随访,平均随访15.8个月(6～48个月). 结果 手术时间平均为45 min(40～65 min).术后Rowe肩关节修正评分80～95分,结果伞为优,成功率100%.随访期间无复发与并发症. 结论 改良小切口Bristow手术较传统Bristow手术切口小,手术创伤小,手术时间短,临床效果好.     

关节镜下Twinfix锚钉治疗肩关节Bankart损伤48例

肩关节是最不稳定及最常脱位的关节之一,占全部关节脱位的50％,一般人群发病率为2％.外伤所致的肩关节前脱位常导致盂肱关节前下方盂唇关节囊盂肱韧带复合体的附着处撕脱性损伤,称为Bankart损伤.发生率最高的肩关节脱位损伤为基于Bankart损伤的复发性肩关节前脱位[1].从关节镜下经肩盂下方打孔过线固定盂唇及关节囊的肩...     

关节镜下关节囊修补术治疗复发性肩关节前脱位合并HAGL损伤的临床疗效北大核心CSCD

目的:探讨关节镜下关节囊修补术对复发性肩关节前脱位合并盂肱关节下韧带自肱骨附着点的撕脱(humeral avulsion of glenohumeral ligament,HAGL)损伤的临床疗效。方法:应用关节镜下关节囊修补术治疗合并HAGL损伤的复发性肩关节前脱位患者9例,平均随访时间24.2个月。分别于术前、术后对患者进行体格检查,并采用美国肩肘外科协会评分(American Shoulder&Elbow Surgeons’score,ASES)、Constant-Murley评分和Rowe评分以及是否存在术后再脱位或残存恐惧试验阳性来评价肩关节功能。结果:我院复发性肩关节前脱位患者中HAGL损伤的发病率为0.8%。合并HAGL损伤的复发性肩关节前脱位患者术前患肢主动前屈146.1±43.3°,体侧外旋53.9±8.6°,内旋达到T12(T7～LS);肩关节ASES评分76.8±21.9,Constant-Murley评分81.2±15.8,Rowe评分39.4±6.3。末次随访时,无患者出现肩关节复发脱位,恐惧试验皆为阴性;肩关节主动前屈163.2±13.2°,体侧外旋58.9±3.3°,内旋达T12(T7～L3),与术前相比差异均无统计学意义(P=0.068,P=0.157,P=0.180);ASES评分91.4±7.4,Constant-Murley评分91.6±7.5,Rowe评分94.4±8.1,均较术前显著改善(P<0.05)。结论:HAGL损伤是复发性肩关节前脱位患者中较为罕见的损伤类型。关节镜下关节囊修补术治疗合并HAGL损伤的复发性肩关节前脱位患者可取得满意的临床疗效。     

关节镜技术治疗肩关节后脱位4例临床疗效

目的:探讨关节镜下治疗肩关节后脱位及肱骨头前方骨缺损的临床疗效。方法:2010年1月至2012年7月,我们采用关节镜技术治疗4例肩关节后脱位患者,并对其中3例肱骨头缺损在25%~50%的患者行改良镜下Mclaughlin术,术前及术后进行随访并进行Constant评分和UCLA评分。结果:本组病例均复位成功,随访时间平均30.0个月。Constant评分从术前平均20.0分改善至术后平均76.8分。UCLA评分从术前平均13.0分改善至术后33.5分。结论:关节镜下治疗肩关节后脱位,方便、微创、疗效良好、后遗症少。     

多层螺旋CT评价复发性肩关节前方脱位的前方关节盂骨质缺损的临床意义

目的 在复发性肩关节前方脱位中,利用MSCT评估关节盂前方骨质缺损情况.方法 回顾分析108例复发性肩关节前脱位和12例单次肩关节脱位患者的MSCT检查,对比评价前方关节盂骨质缺损的发生率、程度及位置.利用Fisher精确概率法分析前方关节盂骨质缺损的发生率,利用Wilcoxon秩和检验比较前方关节盂骨质缺损的上下长径、深度及比例.结果 在复发性肩关节前脱位中,91.7％(99/108)存在前方关节盂的骨质缺损,缺损比例为(16.0±6.0)％,缺损中心位置介于时钟分区的2:20～ 4:25点(平均3:20点),62.0％(67/108)前方出现骨性Bankart病变,包括游离型39例(58.2％)及黏附型28例(41.8％).12例单次肩关节脱位中,9例出现前方关节盂骨质缺损,其缺损发生率(9/12;P=0.100)和缺损比例[(15.2±7.1)％;P=0.453]与复发性肩关节脱位比较差异均无统计学意义.结论 前方关节盂骨质缺损为复发性肩关节前方脱位的常见表现.     

关节镜下盂唇修补合并改良Remplissage术治疗伴Hill-Sachs损伤肩关节前方不稳的临床对照研究

目的:研究盂唇修补合并改良Remplissage手术治疗伴肱骨头中小型Hill-Sachs骨性缺损的创伤性复发性肩关节前方不稳的疗效。方法:选取2006年至2010年经影像学检查确诊为伴肱骨头中小型Hill-Sachs损伤的创伤性复发性肩关节前方不稳患者共42例行回顾性随访研究。所有患者均由同一名医生施行关节镜下前方稳定术。根据是否加用改良Remplissage术式分为A、B两组。A组26例,在2006年至2009年行关节镜下单纯盂唇修补术。B组16例,在2009年至2010年行关节镜下盂唇修补术加改良Remplissage术,采用双线锚钉将后方关节囊(非冈下肌腱)填充于肱骨头缺损处。两组患者术后采用相同方法进行康复训练。采用牛津肩关节不稳评分(OSIS)和ROWE评分进行疗效评估、对比术前和术后3个月、6个月、9个月及12个月时肩关节活动度。结果:所有患者均获得随访,A组随访平均(28.0±5.6)个月(20～38个月);术前、术后OSIS评分分别为(37.0±4.2)分(27～43分)和(18.0±3.3)分(12～25分),ROWE评分分别为(20.2±12.2)分(5～40分)和(83.8±7.3)分(70～95分);术后再脱位患者1例,由再次创伤造成,半脱位患者5例。B组随访平均(19.6±3.8)个月(14～27个月);术前、术后OSIS评分分别为(37.9±4.9)分(29～44分)和(13.4±2.1)分(12～20分),ROWE评分分别为(18.4±8.3)分(5～30分)和(95.3±5.3)分(80～100分);术后无再脱位患者。对两组患者术后肩关节活动度分别测量的结果显示,两组患者术后中立位外旋活动度恢复趋势无明显差异。Kaplan-Meier生存分析显示,两组患者术后不稳复发率差异有统计学意义(P=0.043)。结论:关节镜下盂唇修补合并改良Remplissage手术是治疗伴肱骨头中小型Hill-Sachs损伤的创伤性复发性肩关节前方不稳的有效方法,可显著提高肩关节稳定性,并对术后肩关节活动度无明显影响。     

The surgical outcome of immediate arthroscopic Bankart repair for first time anterior shoulder dislocation in young active patients

This study evaluated the surgical outcomes of young active patients with arthroscopic Bankart repair within 1 month after first-time anterior shoulder dislocation. From July 2002–October 2004, patients presented with first-time traumatic anterior shoulder dislocation and treated with arthroscopic stabilization within 1 month of injury were retrospectively reviewed. Magnetic resonance imaging and computed tomography were performed before the operation in all cases. Cases with contralateral shoulder multidirectional instability or glenoid bone loss of more than 30% on preoperative computed tomography on the injury side were excluded. All patients were treated with arthroscopic Bankart repair, using metallic suture anchors or soft tissue bio-absorbable anchors by a same group of surgeons and followed the same rehabilitation protocol. Recurrence, instability signs, range of motion, WOSI score, Rowe score and complications were assessed. Thirty-eight patients were recruited: the average age was 21 (16–30). All patients had definite trauma history. Radiologically, all patients had Bankart/Hill-Sachs lesion. All the operations were done within 1 month after injury (6–25 days). The average hospital stay was 1.2 days (1–5 days). The average follow-up was 28 months (24–48 months). There were two cases of posttraumatic re-dislocation (5.2%). The average external rotation lag was 5° (0–15) in 90° shoulder abduction when compared with contralateral side. 95% of patients had excellent or good Rowe score. The average WOSI score was 83%. There was one case of transient ulnar nerve palsy and one case of superficial wound infection. This study concluded that immediate arthroscopic Bankart repair with an accelerated rehabilitation program is an effective and safe technique for treating young active patients with first-time traumatic anterior shoulder dislocation. This study complies with the current laws of the Hong Kong Special Administration Region Government.     

The modified Bristow procedure for anterior shoulder instability: 26-year outcomes in Naval Academy midshipmen

BACKGROUND: Many procedures have been proposed for the correction of anterior shoulder instability. Some of these procedures address the problem anatomically, such as the Bankart procedure, and some prevent instability nonanatomically, such as the Bristow-Latarjet procedure. A modified Bristow procedure was the procedure of choice for anterior shoulder instability among midshipmen at the United States Naval Academy from 1975 to 1979. HYPOTHESIS: The modified Bristow procedure for anterior shoulder instability provides good shoulder function and stability in the long term. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: There were 52 shoulders in 49 patients reviewed at a mean follow-up of 26.4 years. The Rowe score, Single Assessment Numeric Evaluation, and Western Ontario Shoulder Instability Index were used to assess outcomes. RESULTS: The mean Rowe score was 81.8 (range, 5-100), and the mean Single Assessment Numeric Evaluation score was 82.9 (range, 30-100), with an overall Single Assessment Numeric Evaluation of 71.2% (37 of 52 shoulders) rated as good and excellent. The mean Western Ontario Shoulder Instability Index was 376 of 2100 (range, 0-1560). Overall, recurrent instability occurred in 8 of 52 shoulders (15.4%), with recurrent dislocation in 5 shoulders (9.6%) and recurrent subluxation in 3 shoulders (5.8%). The mean time to recurrent dislocation was 7.0 years. CONCLUSION: This study represents the longest follow-up in the literature of the modified Bristow procedure. The authors have shown nearly 70% good and excellent results and recurrent instability comparable with other long-term follow-up studies of open instability procedures.     

A prospective outcome evaluation of arthroscopic Bankart repairs: minimum 2-year follow-up

BACKGROUND: Arthroscopic treatment of anterior shoulder dislocation has become possible through improvements in instruments and techniques. OBJECTIVE: To prospectively evaluate results of arthroscopic Bankart repairs at a minimum 2-year follow-up for patients with histories of shoulder dislocation and an anterior-inferior labral tear at the time of diagnostic arthroscopy. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A consecutive series of 85 patients (70 men, 15 women; mean age, 26 years) with Bankart lesions were treated with arthroscopic repair using suture anchors; 18 patients (27%) had extension of the labral injury into the superior labrum affecting some or all of the biceps anchor. Anchors were loaded with no. 2 nonabsorbable braided suture and placed 2 mm into the edge of the glenoid surface. A low anterior (5-o'clock) portal through the subscapularis tendon was used in all patients; 72 patients were evaluated at a minimum of 2 years postoperatively (mean, 46 months). RESULTS: Seven patients (10%) experienced recurrent instability after repair. Four patients had redislocations; 3 experienced recurrent subluxations. One patient had pain with the apprehension test without a clear history of recurrent instability. Of 18 collision athletes, 2 had dislocations at 22 and 60 months postoperatively. There were no complications, including no neurologic deficits. Clinical strength testing of the subscapularis muscle was normal in all patients. The mean Rowe score was 88 of 100 points, with 90% excellent or good results. Simple Shoulder Test responses improved from 66% positive preoperatively to 88% positive postoperatively. The American Shoulder and Elbow Surgeons scoring index averaged 92 of 100 points postoperatively. Pain analog scales improved from 5.5 preoperatively to 0.35 postoperatively on a 10-point scale. SF-12 scores improved for physical function. Patient satisfaction was rated 8.9 on a 10-point visual analog scale. CONCLUSION: Bankart repairs performed arthroscopically using properly implanted suture anchors and nonabsorbable sutures and in which associated pathoanatomy is addressed demonstrate low recurrence rates (10%) similar to historical open controls.     

Revision of failed arthroscopic bankart repairs

BACKGROUND: The results following open revision surgery following a failed arthroscopic Bankart procedure are not well documented. PURPOSE: To evaluate the results of patients with a failed arthroscopic Bankart repair treated with a traditional, open Bankart repair. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Thirty patients (28 male and 2 female) who had a mean age of 24 years (range 15-36) at the time of operation were evaluated. The mean interval from the time of the operation to the final follow-up was 46 months (range 24-55). The rating systems of Rowe and the University of California at Los Angeles (UCLA) were recorded preoperatively and at the time of the final evaluation. RESULTS: After open repair, mean modified Rowe scores improved from 25 preoperatively to 84.2 points. The results were excellent in 2 (6.7%), good in 24 (80%), and fair in 4 (13.3%); there were no poor results. The UCLA shoulder score improved from a mean of 17 points preoperatively to 29 points (P = .001 for all comparisons). Twenty-six patients (87%) did not have an anchor placement inferior to the 4-o'clock position for a right shoulder or the 8-o'clock position for the left shoulder after the index arthroscopic repair. There were no rotator interval closures performed at the index arthroscopic Bankart repair, and 10 patients (33%) required an interval closure at the open revision procedure. Twenty-five patients (83%) immobilized the operated arm in a sling for less than 2 weeks following the index arthroscopic repair. CONCLUSION: Patients with failed arthroscopic Bankart repairs can be successfully treated with a revision, open Bankart repair. Inadequate postoperative immobilization, large rotator intervals, and improper anchor placement are possible risk factors that may increase the incidence of failure of an arthroscopic Bankart repair.     

Revision using modified transglenoid reconstruction in recurred glenohumeral instability combined with anchor-induced arthropathy

A 25-year-old man presented with a history of pain and crepitus in the right shoulder; he had been previously treated with arthroscopic anterior stabilization using four metallic suture anchors for recurrent traumatic anterior instability 1 year earlier. In this report, we present a patient with recurrent glenohumeral instability combined with anchor-induced arthropathy who was managed with modified arthroscopic transglenoid reconstruction following arthroscopic suture anchor retrieval.     

Early arthroscopic treatment of primary traumatic anterior shoulder dislocation. A follow-up study

This study evaluates the results of early arthroscopic Bankart repair in patients with primary traumatic anterior dislocation of the shoulder. The patients'age range was 17–34 years. Arthroscopic Bankart repair was performed within 12 days after the dislocation. First follow-up was at 18 months. According to Rowe's score, 11 patients (73%) were excellent, 3 (20%) were good and 1 (7%) was poor. The median external rotation deficit was 4 in the adducted position. At a second follow-up at 34 months, two patients had redislocated. Both of these patients had severe generalized joint laxity. Another patient reported frequent subluxations. We conclude that in young patients with primary anterior traumatic shoulder dislocation, early arthroscopic Bankart repair implies a low recurrence rate and restores shoulder function to normal. Generalized joint laxity could indicate an increased risk for recurrent dislocation.     

Open Bankart repair versus arthroscopic repair with transglenoid sutures or bioabsorbable tacks for Recurrent Anterior instability of the shoulder: a meta-analysis

BACKGROUND: In published comparative studies, it remains unknown if arthroscopic techniques for performing Bankart repair for anterior shoulder instability equal the success of open repair. HYPOTHESIS: The current literature supports a lower rate of recurrent instability after open Bankart repair compared to arthroscopic repair with bioabsorbable tacks or transglenoid sutures. STUDY DESIGN: Meta-analysis. METHODS: A Medline search identified all randomized controlled trials or cohort studies that directly compared open repair to arthroscopic techniques of Bankart repair for traumatic, unilateral, recurrent anterior instability. Data collected from each study included patient demographics, surgical technique, rehabilitation, outcome, and complications. RESULTS: Six studies met all inclusion criteria. There were 172 patients in the arthroscopic group (90 patients with transglenoid sutures, 77 patients with arthroscopic tacks, and 5 patients with suture anchors) and 156 patients in the open group. The groups were similar in demographic characteristics. When comparing the arthroscopic to the open group, there was a significantly higher rate of recurrent dislocation (12.6% vs 3.4%; P = .01) and total recurrence (recurrent dislocation or subluxation) (20.3% vs 10.3%; P = .01). In addition, there was a higher proportion of patients with an excellent or good postoperative Rowe score in the open group (88%) than in the arthroscopic group (71%) (P = .01). CONCLUSIONS: Arthroscopic Bankart repair using transglenoid sutures or bioabsorbable tacks results in a higher rate of recurrence of instability compared to open techniques. Studies comparing open repair to newer arthroscopic techniques using suture anchor fixation and capsular plication are necessary.