镜下缝线锚钉修复肩关节上盂唇前后向合并前后延伸损伤的疗效分析

目的 探讨镜下缝线锚钉修复肩关节上盂唇前后向(SLAP)合并前后延伸损伤的疗效.方法 对2007年3月至2009年4月肩关节镜下缝线锚钉修复的12例盂唇SLAP合并前后延伸损伤患者的资料进行回顾性分析,男7例,女5例;年龄18～40岁,平均28.7岁;均为复合多向不稳定.镜下缝线锚钉治疗肩关节盂唇SLAP Ⅴ型损伤(Bankart损伤+SLAPⅡ型损伤)7例、SLAPⅧ型损伤(SLAPⅡ型损伤合并后下方盂唇撕裂)3例及SLAPⅢ型合并前后盂唇撕裂脱位2例.术前及术后随访均采用美国肩肘外科协会(ASES)评分、视觉模拟评分(VAS)及Constant-Murley评分评定疗效.结果 所有患者术后获11～22个月(平均17个月)随访.术前及末次随访时肩关节平均前屈上举分别为163.4°±8.6°和169.7°±4 2°;外展90°外旋为58.5°±13.6°和90.3°±5.5°;术后外展90°,患侧外旋角度较健侧受限8.4°±6 2°.术前及末次随访ASES评分分别为(77.4±3.7)分和(94.3±2.6)分,VAS评分分别为(7.2±1.4)分和(1.2±0.6)分,Constant-Murley评分分别为(78.1±4.6)分和(93.9±3.7)分,以上指标比较差异均有统计学意义(P＜0.05).术后未发生再脱位,均重返伤前工作岗位.结论 严重SLAP合并前后延伸损伤诊断困难,镜下能明确损伤类型,及时治疗,创伤小,并发症少,功能恢复快.     

关节镜下非打结型缝合锚钉修补Bankart损伤治疗复发陛肩关节前脱位

目的 探讨关节镜下非打结型缝合锚钉修补Bankan损伤治疗复发性肩关节前脱位的疗效.方法 复发性肩关节前脱位患者14例,均为男性;年龄18～34岁,平均25.2岁;左侧4例,右侧10例,涉及主力侧12例;均为单向不稳.术前脱位次数为3～36次,平均13.5次.关节镜下采用可吸收非打结型缝合锚钉治疗Bankart损伤.术前及术后随访采用ASES评分及Constant-Murley功能评估.结果 所有患者均获得随访,随访时间11～22个月,平均17个月.术中发现9例合并Hill-Sachs损伤,3例合并骨性Bankart损伤,2例合并后下盂唇损伤,2例合并SLAPⅡ型损伤,1例合并关节内游离体.14例患者术前及末次随访时肩关节平均前屈上举为163.4°±8.6°和169.7°±4.2°;外展90°时,平均外旋角度分别为58.5°+13.6°和90.3 °±5.5.;术后外展90°时,患侧外旋角度较健侧受限8.4°±6.2°术前及末次随访时ASES评分为(77.4±3.7)分和(94.3±2.6)分,两者比较差异有统计学意义(P＜0.05);其中VAS不稳定评分平均为(7.2±1.4)分和(1.2 ±0.6)分(P＜0.01);Constant-Mudey评分平均为(78.1±4.6)分和(93.9±3.7)分.术后无一例患者发生再脱位,且均重返伤前工作岗位.结论 肩关节镜下Bankart 重建手术是治疗复发性肩关节脱位的有效方法 .非打结型缝合锚钉简化了手术操作步骤,减少手术时间和创伤.     

关节镜下非打结型与打结型缝合锚钉Bankart重建治疗复发性肩关节前向不稳

目的探讨关节镜下非打结型与打结型缝合锚钉对复发性肩关节前向不稳Bankart损伤的临床效果。方法回顾性分析2006年3月至2009年1月广州军区广州总医院收治的44例复发性肩关节脱位Bankart损伤患者的临床资料,根据关节镜下修复方式的不同分为非打结组（可吸收非打结型缝合锚钉修复,20例）和打结组（打结型缝合锚钉修复,24例）。采用美国肩肘外科医师（ASES）评分及Constant-Murley功能评分对患者术前、末次随访时肩关节功能进行评估,记录肩关节活动范围,观察并发症发生情况。结果所有患者获得随访,随访时间20～46个月,平均随访时间30个月。非打结组术前和终末随访时肩关节前屈上举角度、外展90°时外旋角度分别为（163±9）°和（170±4）°、（58±14）°和（90±6）°,术后外展90°时患侧外旋角度较健侧受限（8±6）°;术前和终末随访时ASES评分、Constant-Murley评分分别为（77.4±3.7）分和（94.3±2.6）分、（78.1±4.6）分和（93.9±3.7）分,两者比较,差异有统计学意义（P〈0.05）。打结组术前和终末随访时肩关节前屈上举角度、外展90°时外旋角度分别为（162±8）°和（170±6）°、（61±13）°和（91±6）°,术后外展90°时患侧外旋角度较健侧受限（5±3）°;术前和终末随访时ASES评分、Constant-Murley评分分别为（75.8±2.9）分和（95.1±3.7）分、（76.2±5.9）分和（92.8±5.2）分,两者比较,差异有统计学意义（P〈0.05）。两组间术前、术后各项指标比较,差异无统计学意义（P〉0.05）。患者均未出现术后再脱位,均重返伤前工作岗位。结论肩关节镜下Bankart重建手术是治疗复发性肩关节前向不稳的有效方法,非打结型和打结型缝合锚钉修复Bankart损伤疗效相似。     

肩关节镜下锚钉固定位置与跨度对治疗复发性肩关节前脱位预后的影响

目的 评估肩关节镜下锚钉内固定术治疗复发性肩关节前脱位的临床疗效,并探讨锚钉固定位置、跨度对临床疗效的影响。方法 2013年1月至2016年6月,前瞻性纳入47例复发性肩关节前脱位病人,关节镜下使用3枚Lupine锚钉固定撕裂的盂唇。术后第2日常规复查肩关节三维CT,以表盘上的时间刻度描述锚钉位点及跨度。采用数字分级法（numerical rating scale, NRS）评估病人的疼痛程度;使用美国肩肘外科医师学会（American Shoulder and Elbow Surgeons, ASES）评分及Constant-Murley评分评估手术前后关节功能。使用丹麦健康与医疗管理局（Danish Health and Medicine Authority）满意度评分表评估病人满意度。分析锚钉固定位置、跨度等因素与Constant-Murley评分的关系。结果 47例病人术后未出现明显并发症,术后的NRS评分、ASES评分、Constant-Murley评分均较术前显著改善,差异均有统计学意义（P均＜0.05）。病人满意度评分为（8.2±1.3）分。锚钉跨度越大,Constant-Murley评分越低（F=21.714,P＜0.001）;锚定位置越高（越接近12点钟位置）,Constant-Murley评分越低（F=13.752,P=0.006）。结论 锚钉固定前下盂唇可有效改善病人肩关节功能,有利于肩关节稳定性重建,且锚钉固定的位置及跨度与肩关节术后稳定性相关。     

关节镜下GⅡ锚钉固定治疗肩关节Bankart损伤

目的探讨关节镜下GⅡ锚钉固定治疗肩关节Bankart损伤的疗效。方法对3例肩关节不同类型Bankart损伤的患者行关节镜下GⅡ锚钉固定、缝合关节囊重建撕裂的盂唇。术后按常规康复治疗。结果 3例均获随访,时间分别为9、11、8个月,无复发脱位。UCLA评分由术前23.4、21.8、24.7分提高至术后32.8、32.5、40.2分,差异有统计学意义（P〈0.01）。结论关节镜下GⅡ锚钉固定治疗肩关节Bankart损伤切口小,愈合快,疗效好。     

关节镜下盂唇缝合治疗肩关节前脱位

目的探讨关节镜下盂唇缝合治疗肩关节前脱位的临床疗效。方法采用关节镜下盂唇缝合锚钉固定治疗12例肩关节前脱位患者。结果 12例肩部疼痛均消失,其中1例肩关节后伸受限。12例均获随访,时间9～24（12±8）个月。术前UCLA评分为（18.5±4.2）分,术后为（32.8±1.5）分,差异有统计学意义（P〈0.05）;肩关节前屈上举术前为（115.4±12.0）°,术后为（163.3±8.2）,°差异有统计学意义（P〈0.05）。患者均恢复原有工作、运动。结论关节镜下盂唇缝合治疗肩关节前下脱位效果良好,具有诊断与治疗一体化优点,同时可以处理合并损伤。     

关节镜下经肩胛冈入路切除冈盂切迹囊肿28例随访1年结果北大核心CSCD

目的 探讨关节镜下经肩胛冈入路切除冈盂切迹囊肿的临床疗效。方法 回顾性分析2014年6月~2020年6月28例冈盂切迹囊肿手术和随访资料,其中4例单纯冈盂切迹囊肿,21例合并肩关节上盂唇前后部(superior labrum anterior and posterior, SLAP)损伤,1例合并后盂唇损伤,2例合并前下盂唇损伤。关节镜下经肩胛冈入路(冈上肌和冈下肌间隙)完全切除囊肿,并处理合并肩关节病变如SLAP损伤、肩袖损伤等。随访期1年,通过Constant-Murley评分、改良美国加州大学(UCLA)肩关节评分和肌力评分评估肩关节功能,行MRI明确囊肿是否复发。结果 28例术后无严重并发症,临床症状均较术前明显改善,术后1年Constant-Murley评分、改良UCLA评分均较术前明显提高[(48.5±7.0)分vs.(95.6±3.4)分,t=-35.804,P=0.000;(17.0±8.3)分vs.(32.3±3.7)分,t=-9.371,P=0.000],7例冈下肌萎缩者肩外旋肌力较术前显著提高[(5.4±3.5)kg vs.(10.7±2.9)kg,t=-2.937,P=0.026]。术后1年复查MRI均未见囊肿复发。结论 关节镜下经肩胛冈入路完全切除冈盂切迹囊肿、处理合并肩关节损伤,可改善临床症状,避免囊肿复发。     

肩关节上盂唇前后向损伤的关节镜治疗

目的 探讨关节镜治疗肩关节上盂唇前后向(SLAP)损伤的临床效果.方法 对2000年1月垒2007年12月问肩关节镜下技术治疗的29例肩关节SLAP损伤患者的治疗效果进行评估,男21例,女8例;左肩4例,右肩25例;优势肩27例,非优势肩2例.本组病例不包含合并肩峰下撞击征、肩袖撕裂、肩关节脱位为卡要表现的患者.手术前、后均采用ASES评分及UCLA评分埘患者肩关节功能进行评估.结果 关节镜探查情况:将SLAP损伤分为九型,本组SLAPⅠ型2例,SLAPⅡ型17例.SLAPⅢ型1例,SLAPⅣ3例,SLAPV型1例,SLAPⅥ型1例,sLAPⅧ型4例.29例患者获平均26.1个月(9～89个月)随访.手术前、后肩关节评分ASES评分平均分别为(9.19±1.77)、(16.08±0.94)分,差异有统计学意义(t=19.79,P=0.000).手术前、后肩关节UCLA评分平均分别为(19.23±3.88)、(33.23±2.08)分,差异有统计学意义(t=17.54,P=0.000).25例达到伤前运动水平,症状完全解除;3例活动轻微受限;1例随访时疼痛症状较术前轻微缓解.13例运动员全部达到了伤前运动状态,平均力量训练时间为16.3周(3～30周),平均专项训练时间为19.1周(12～30周),平均比赛训练时间为27.3周(12～52周),正式比赛时问平均为28.1周(16～52周).无血管、神经损伤和感染患者.结论 肩关节镜技术治疗SLAP损伤安全、有效,尤其对运动员SLAP损伤更有意义.     

老年陈旧性锁定型盂肱前脱位的镜下治疗

[目的]介绍老年陈旧性锁定型盂肱前脱位的镜下治疗手术技术与初步临床效果。[方法] 2016年1月—2020年12月,对5例陈旧性锁定型患者采用镜下手术治疗。镜下切除瘢痕组织,复位盂肱关节。于Hill-Sachs损伤中间置入2枚锚钉。暴露盂肱盂前部和下部的骨缺损区域,用刮匙将肩胛盂骨缺损创面新鲜化。取2 cm×2 cm×1 cm的双皮质骨块,按受区大小和形状修整。建立前下入路,将骨块置于关节盂前下缘,使用2枚空心钛拉力螺钉固定骨块。在肩盂前缘1～7点处根据需要置入2～4枚锚钉,缝合前方关节囊及盂唇,收紧后方缝线,进行冈下肌填塞;部分病例修复肩袖损伤。[结果] 5例患者均顺利完成手术,均无严重并发症。随访9～18个月,平均（11.5±3.1）个月。末次随访时前屈上举活动度、ASES、Constant-Murley和Rowe评分均较术前显著改善（P<0.05）。至末次随访时,所有患者均无盂肱不稳复发,无翻修手术。CT检查证实植骨已与盂前愈合,盂肱对合良好。[结论]本镜下手术集中体现了关节镜手术的优点,能够有效复位盂肱关节,同时重建关节盂,修复前侧关节囊的Hill-Sachs损伤,是治疗...     

肩关节盂唇损伤的关节镜诊断和治疗

目的 探讨肩关节镜诊断和治疗盂唇损伤的应用意义和临床疗效。方法 对明确诊断盂唇损伤的36例病例,进行X线检查、单纯造影、MR加造影和关节镜技术的比较总结回顾。28例单纯盂唇损伤,采用肩关节镜下损伤盂唇的部分切除术;5例合并肱二头肌长头腱复合体（SLAP）病损,采用肩关节镜下盂唇损伤处清创术,术后患肩零度位牵引;3例合并Bankart病损,行肩关节镜下盂唇损伤处清创术后,通过有限切口进行改良的Bristow手术。结果 术后随访10个月～3年,平均2年。参照美国Michasel Reese医疗中心的评分标准,疼痛评分总分75分:术前平均35分,术后平均65分。关节功能评分总分25分:术前平均10分,术后平均20分。全部病例术后临床症状均有明显改善,恢复日常生活与工作,8例合并SLAP或Bankart病损者,术后未出现肩关节不稳定症状。结论 盂唇是肩关节内损伤的好发部位之一。肩关节镜是明确诊断和治疗盂唇损伤的有效的先进技术。肩关节镜下手术有一定难度,需特备的手术器械,因此要求术者熟练掌握肩关节镜技术。     

Effects of biceps tension on the torn superior glenoid labrum

The purpose of this study was to evaluate the role of the tension on the long head of the biceps tendon in the propagation of SLAP tears by studying the mechanical behavior of the torn superior glenoid labrum. A previously validated finite element model was extended to include a glenoid labrum with type II SLAP tears of three different sizes. The strain distribution within the torn labral tissue with loading applied to the biceps tendon was investigated and compared to the inact and unloaded conditions. The anterior and posterior edges of each SLAP tear experienced the highest strain in the labrum. Labral strain increased with increasing biceps tension. This effect was stronger in the labrum when the size of the tear exceeded the width of the biceps anchor on the superior labrum. Thus, this study indicates that biceps tension influences the propagation of a SLAP tear more than it does the initiation of a tear. Additionally, it also suggests that the tear size greater than the biceps anchor site as a criterion in determining optimal treatment of a type II SLAP tear. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1545–1551, 2015.     

Double bucket handle tear of the superior labrum in a young patient presented with shoulder instability treated with arthroscopic debridement: A case report

Introduction and importanceThe two major etiologies of shoulder superior labral tears anterior to posterior (SLAP) are traumatic and degenerative processes. Bucket handle tears of the superior labrum represent one-third of labral lesions. However, in this article, we present a double bucket handle tear which has been reported once in the literature.Presentation of caseA 25-year-old male presented with complaint of chronic pain in his right shoulder with a remote history of traumatic dislocation. Physical examination revealed a positive apprehension test. Shoulder magnetic resonance imaging (MRI) showed a superior labral tear with a Hill-Sach lesion. Arthroscopy showed a double bucket handle tear of superior labrum and mild biceps tendonitis along with Bankart lesion. The tear was resected and the Bankart lesion was repaired followed by supervised physical therapy. Good clinical outcomes in form of resolution of pain and shoulder instability at six months were obtained.DiscussionSLAP tears are common shoulder lesion that is reported differently in the literature. Arthroscopic studies had reported the incidence between 3.9%-11.8. The diagnosis of such lesion relies on the clinical presentation and imaging. Knesek et al. classified SLAP lesions based on the integrity of the biceps anchor and the type of labral tear (Knesek et al., 2013). The standard treatment of symptomatic SLAP lesions is Arthroscopic debridement. However, non-operative management was described in the literature.ConclusionDouble bucket handle injuries of the superior labrum are reported in literature once. These lesions can be treated with arthroscopic debridement and Bankart repair and followed by supervised physical therapy.     

Combined Arthroscopic Repair of a Type IV SLAP Tear and Bankart Lesion

Lesions of the superior labrum can be a source of significant shoulder pain and disability. SLAP (superior labrum anterior-posterior) tears have been classified into many different types. A type IV SLAP tear is a bucket-handle tear of the superior labrum with extension into the biceps tendon. This relatively uncommon SLAP tear, if present, has been shown to be frequently associated with other pathology including Bankart lesions. We present an arthroscopic technique for combined repair of a type IV SLAP tear and Bankart lesion. Steps include initial reduction of the bucket-handle portion of the superior labral injury, repair of the anterior-inferior labral detachment, and, finally, repair of the superior labrum and biceps tendon split.     

关节镜下手术治疗创伤性肩关节前不稳定

目的探讨关节镜下手术治疗创伤性肩关节前不稳定的治疗原则、操作要点以及临床效果。方法2002年9月至2005年5月,本组患者18例,其中运动伤12例,工伤5例,交通伤1例。受伤至就诊时间平均15周。临床表现为肩痛18例,肩活动受限15例。前惧痛征(apprehension)阳性18例;肱二头肌牵拉征(speed)阳性5例;X线出现Hill-Satchs征3例。气-碘双重对比造影CTⅠ度1例,Ⅱ度15例,Ⅲ度2例。手术情况镜下见前盂唇撕脱18例,前关节囊松弛4例,合并上方盂唇撕裂(SLAP损伤)4例,游离体3例,盂唇骨赘形成2例,肱骨头、肩胛盂软骨剥脱2例;分别给予关节镜下前盂唇缝合锚钉固定(18例),前关节囊松弛紧缩术(3例),肱二头肌腱刨削(2例),关节囊外重新附着固定(2例),上盂唇缝合(3例),刨削(1例)等处理。术前UCLA肩关节评分(14±3)分。结果18例患者平均随访18个月(10~32个月)。所有患者肩部疼痛消失。1例于剧烈活动后肩部酸困感。肩部活动受限3例,其中后伸受限10°1例,肩外旋受限2例(<20°),前惧痛征1例有轻度不适,余体征均为阴性。所有患者恢复原工作、运动。术后UCLA肩关节评分(32±5)分,与术前比较差异有统计学意义(t=14.081,P<0.01)。结论关节镜下治疗创伤性肩关节前不稳定可取得良好效果。熟练操作技术,准确判定前盂唇充分松解及复位、固定,并正确处理合并损伤十分重要。带线锚钉固定前盂唇可靠,操作简便。     

Avulsion of the superior labrum

Snyder et al. coined the term superior labral anterior and posterior (SLAP) lesion and classified SLAP lesion into 4 types. Morgan et al. developed a secondary classification of Snyder type II lesions based on the anatomic location. Maffet et al. found that some lesions could not be classified according to classification of Snyder et al.; types V to VII were added to the 4-part classification. In this study, we present the case of a patient with a superior labral tear that could not be classified to any of the reported classification. The superior labrum was detached with cartilage exposing the underlying bone of the glenoid.     

Arthroskopische Schulterstabilisierung mittels Fadenankern unter besonderer Berücksichtigung des tiefen anterior-inferioren Zugangs (5:30 Uhr)

OBJECTIVE: Arthroscopic (re)stabilization of the unstable shoulder by anatomic refixation of the detached capsulolabral complex with suture anchors or reduction of excessive capsule volume by capsule plication. INDICATIONS: Any type of shoulder instability (anterior, posterior, inferior, or multidirectional instability). Revision stabilization (even after primary open stabilization). Bone defects affecting < 25% of the glenoid surface. Lesions of the superior biceps tendon anchor complex (SLAP lesion). CONTRAINDICATIONS: Preexisting bone defects of the glenoid affecting > 25% of the glenoid surface. "Engaging" Hill-Sachs defects: osseous defects of the humeral head that engage with the anterior glenoid rim in extreme external rotation/abduction and consequently lead to shoulder dislocation. Bone-related etiology, e. g., clearly increased glenoid retroversion/anteversion or glenoid dysplasias (e. g., inverse pear shape). Voluntary shoulder dislocation in young patients until the end of the growth period. SURGICAL TECHNIQUE: Diagnostic arthroscopy and additional procedures based on clinical and intraoperative findings. For anterior-inferior instability, an anterior-superior approach is made with mobilization of the labrum and decortication of the glenoid. Creation of deep anterior-inferior portal and insertion of the anchors in 5.30, 4.30 and 3.00 o'clock position. The sutures are pulled through the capsulolabral complex and tied arthroscopically. Reconstruction of the inferior glenohumeral ligament is especially important. Lesions of the superior biceps tendon anchor and/or posterior labrum detachment can be treated by the same technique. Capsule plication with PDS sutures can be performed to decrease a large rotator interval or excessive capsule volume. The range of motion at the shoulder is limited for 6 weeks postoperatively (depending on the initial direction of the instability). RESULTS: At the authors' hospital over 600 arthroscopic shoulder stabilizations using the deep anterior-inferior portal have been completed so far. The redislocation rate for the first 147 patients (average follow-up of 3 years) treated with the technique described here is 6.1% and is slightly higher for arthroscopic revision stabilizations (n=43; of these, redislocation n=3 and reinstability n=3). There were no instances of axillary nerve lesion.     

Slap variant with an absent long head of biceps

Congenital absence of the long head of biceps is a rare arthroscopic finding. We present a unique case of congenital absence of the long head of biceps tendon in the presence of a Superior labrum anterior posterior (SLAP) variant lesion. Current theories regarding the aetiology of SLAP lesion consider the long head of biceps tendon to either avulse or peel-off the labrum from the glenoid rim. Our finding of SLAP variant lesion in the absence of the long head of biceps tendon suggests that other processes must play a part in the causation of this injury, independent of the long head of biceps.     

Magnetic resonance imaging diagnosis, sonographically directed percutaneous aspiration, and arthroscopic treatment of a painful shoulder ganglion cyst associated with a SLAP lesion.

A 30-year-old, right-handed man presented with the insidious onset of right shoulder pain associated with overhead activities. Magnetic resonance imaging revealed a perilabral ganglion cyst associated with a SLAP lesion (lesion of the superior labrum, both anterior and posterior). After unsuccessful treatment with sonographically directed percutaneous aspiration of the cyst, arthroscopic techniques were employed to intra-articularly decompress the cyst and stabilize the labral tear.