两种手术方法治疗习惯性肩关节前下脱位的比较

目的 对比研究小切口改良Bristow手术和关节镜下带线锚钉修复Bankart损伤治疗肩关节习惯性前下脱位的临床疗效.方法 2004年6月至2008年1月对20例习惯性肩关节前下脱位患者根据其经济状况进行分组,11例采用小切口改良Bristow手术,为小切13组;9例采用关节镜下带线锚钉垂直褥式缝合修复Bankart损伤,为关节镜组.回顾分析两组的手术时间、术后Rowe肩关节功能修正评分;观察两组的复发率与并发症发生情况.结果 手术时间:小切口组平均为45 min,关节镜组平均为51min.术后Rowe肩关节修正评分:小切口组为80～95分,关节镜组为75～94分.小切口组11例患者术后获6～48个月(平均15.8个月)随访.关节镜组9例患者术后获18～38个月(平均26个月)随访.两组结果全为优,优良率为100%,随访期间均无复发及并发症发牛.结论 小切口改良Bristow手术与关节镜下Bankart损伤修复手术临床效果无明显差别,均较满意,且具有手术切口小、创伤小、手术时间短等优点.前者手术易于临床普及.

Treatment of recurrent anterior-inferior glenohumeral dislocations

Objective To compare the clinical outcomes between mini-open modified Bristow pro-cedure and arthroscopic Bankart lesion repair in the treatment of recurrent anterior-inferior glenohumeral dis-locations. Methods From June 2004 to January 2008, 20 patients with recurrent anterior-inferior shoulder dislocation were assigned into 2 groups at random. Eleven underwent modified Bristow procedures with mini incision (Group A); another 9 cases received the arthroscopic Bankart repair by vertical mattress suture with anchors (Group B). The surgery time, modified Rowe scores after surgery, recurrence and com-plications were compared between the 2 groups. Results The average surgery time was 45 minutes in Group A and 51 minutes in Group B. The modified Rowe scores after surgery ranged from 80 to 95 points in Group A and from 75 to 94 points in Group B. All patients were rated as excellent. The success rate was 100% without any recurrence or complication. Conclusions There is no obvious difference in clinical outcomes between the mini-open modified Bristow procedure and the arthroscopie Bankart lesion repair in the treatment of recurrent anterior-inferior glenohumeral dislocations. Both of them have advantages of small incision, minimal invasion, and short surgery time, but the mini-open modified Bristow procedure is clinically easier.