复发性肩关节前脱位的临床病理表现

目的通过肩关节镜全面了解复发性肩关节前脱位的临床病理表现。方法52例复发性肩关节前脱位患者行关节镜检查,男38例,女14例;年龄16～49岁,平均24.7岁;脱位次数3～15次,平均7.4次。除2例癫痫外,其余50例患者在全麻下行平移试验及Sulcus试验,依照Hawkins分类系统记录试验结果,如果向前、后、下移位超过2°,则为肩关节松弛。50例患者中,32例肩关节松弛,归为关节松弛组,男22例,女10例;18例无肩关节松弛,为单纯创伤性复发性前脱位,归为单纯创伤组,男14例,女4例。记录镜下病理改变并对比两组镜下病理改变的差异。结果51例患者有前下盂唇损伤,50例有Hill-Sachs损伤,32例有肱二头肌腱炎症或损伤,30例有前下盂骨、软骨的损伤,29例有SLAP损伤,7例有肩袖损伤。前下盂唇损伤时,单纯创伤组磨损消失较多(P=0.055),关节松弛组ALPSA损伤较多(59.4%对38.9%,P=0.164)。单纯创伤组前下盂软骨及骨损伤较多(P=0.083,P=0.052)。Hill-Sachs损伤,在关节松弛组以浅或软骨性损伤为主,在单纯创伤组以较宽深或骨性损伤为主。结论复发性肩关节前脱位最常见的病理改变依次为:前下盂唇损伤,Hill-Sachs损伤,肱二头肌腱炎症或损伤,前下盂的骨、软骨损伤,SLAP损伤,肩袖损伤。肩关节松弛伴肩关节复发性前脱位患者镜下病理改变相对较轻。

Clinical pathology of recurrent anterior dislocation of shoulder joint

Objective To comprehensively know clinical pathological change of recurrent anterior dislocation of shoulder joint by arthroscopy. Methods 52 patients with recurrent anterior shoulder dislocation were inspected by arthroscopy in our institute, 38 cases were male, 14 cases were female; the mean age were 24.7, from 16 to 49 years old. 2 epilepsy patients were excluded, the other 50 cases were divided into two groups, the first group included 32 shoulder dislocated patients accompanied with shoulder hyper-laxity. The other group included 18 purely traumatic shoulder dislocated patients. All patients were explored by arthroscopy and all pathological changes were recorded and the difference of pathological change between the two groups were contrasted. Results 51 cases showed anterior-inferior labrum injury, 50 cases showed Hill-Sachs injury, 32 cases showed biceps-tendon inflammation or injury, 30 cases showed bone or cartilage injury of anterior-inferior glenoid, 29 cases showed SLAP injury, 7 cases showed rotator cuff injury. Anterior-inferior labrum injury: labrum abraded disappear was more occurred in pure traumatic group(P=0.055) and ALPSA injury was more in hyper-laxity group (59.4% to 38.9%, P=0.164). Bone or cartilage injury of anterior-inferior glenoid were more occurred in purely traumatic group(P=0.083, P=0.052). Hill-Sachs injury was more superficial or only cartilage injury in hyper-laxity group but wider and deeper in purely traumatic group. Conclusion The general pathological changes of recurrent anterior shoulder dislocation sucessively are: anterior-inferior labrum injury, Hill-Sachs injury, biceps-tendon inflammation or injury, bone or cartilage injury of anterior-inferior glenoid, SLAP injury and rotator cuff injury. The pathological changes of the hyper-laxity group were lighter than purely traumatic group.