中老年人肩关节脱位合并肩袖损伤诊治

目的探讨中老年人肩关节前脱位合并肩袖损伤等多种损伤的诊治方法及疗效。 方法回顾性分析2016年6月至2020年8月长海医院收治的中老年(年龄>40岁)肩关节脱位合并肩袖损伤等多种损伤患者15例。经肩关节镜下手术治疗，术后指导关节功能锻炼，应用美国肩肘医师协会评分(ASES评分)、视觉模拟评分(VAS评分)及Constant评分对患者进行功能评估，结果分析采用配对t检验。 结果14例患者获随访，1例患者因其他原因导致的瘫痪而被排除，平均随访时间(15±4)个月。ASES评分、VAS评分、Constant评分术前为(33.0±11.8)、(5.1±1.4)、(37.4±8.8)，末次随访时为(88.7±6.4)、(0.9±0.7)、(82.3±8.2)，差异有统计学意义(t＝17.341、12.902、13.270，均为P<0.001)。 结论中老年人肩关节脱位常合并肩袖损伤、Bankart损伤或骨性Bankart损伤、Hill-sachs损伤等多种损伤，诊断明确后建议及时手术全面修复，重建肩关节稳定性，缓解疼痛及恢复肩关节功能。

Treatment of shoulder instability with related rotator cuff tears in middle-aged and elderly patients

ObjectiveTo investigate the diagnosis, treatments and related functional outcomes of different surgical choices in middle aged and elderly patients with anterior dislocation of shoulder joint associated with rotator cuff tears and other injuries. MethodsFifteen patients older than 40 with shoulder dislocation complicated with rotator cuff injury and other injuries from June 2016 to August 2020 in ChangHai Hospital were analyzed retrospectively. All the patients were treated by shoulder arthroscopy, and the exercise of joint function was guided after operation. The American Shoulder and Elbow Surgeons scale (ASES), visual analogue scale (VAS) and Constant-Murley score (Constant score)were used to evaluate the function of the shoulder joint. Paired t test was used for data comparison. ResultsFourteen patients were followed up for an average of (15±4) months and one patient was excluded because of paralysis caused by other reasons. The ASES score, VAS score and Constant score were (33.0±11.8), (5.1±1.4), (37.4±8.8) respectively before the operation, and (88.7±6.4), (0.9±0.7), (82.3±8.2) respectively at the last follow-up; the differences were statistically significant (t=17.341, 12.902, 13.270, all P<0.001). ConclusionsShoulder dislocation in the middle aged and elderly is often complicated with rotator cuff injury, Bankart injury or bony Bankart injury, Hill-sachs injury and other injuries. Timely and comprehensive surgical repair should be performed to reconstruct the stability of the shoulder joint, relieve pain and restore the function of the shoulder joint.