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。

Arthroscopy Combined with Modified Remplissage Procedure for Treating Recurrent Traumatic Anterior Shoulder Instability with Hill-Sachs Lesion

Objective To determine if arthroscopic labrum repair plus modified Remplissage procedure in treating recurrent traumatic anterior shoulder instability accompanied with mild to moderate Hill-Sachs lesion has better clinical outcome than the arthroscopic labrum repair only.Methods Forty two patients who underwent arthroscopic anterior shoulder stabilization by a same orthopedist from 2006 to 2010 were retrospectively analyzed.They were divided into two groups based on with or without applying modified Remplissage procedure.Group A included 26 patients treating with arthroscopic labrum repair only(from 2006 to 2009) and group B included 16 patients treating with combined modified Remplissage procedure and arthroscopic labrum repair(from 2009 to 2010).The Oxford Shoulder Instability Questionnaire(OSIS) and Rowe’s score were recorded preoperatively and postoperatively.The ROM was compared before and 3,6,9 and 12 months after operations.Results Patients in group A were followed up for an average of 28.0±5.6 months(20-38 months).Their OSIS scores were 37.0±4.2 points(27-43) and 18.0±3.3 points(12-25) and their Rowe’s scores were 20.2±12.2 points(5-40) and 83.8±7.3 points(70-95) before and after operation.One re-dislocation occurred due to injury,and five subluxations were noticed in group A.Patients in group B were followed up for an average of 19.6±3.8 month(14-27 months).Their OSIS scores were 37.9±4.9 points(29-44) and 13.4±2.1 points(12-20),and their Rowe’s scores were 18.4±8.3 points(5-30) and 95.3±5.3 points(80-100) before and after operation.No re-dislocation or subluxation occurred in group B.The range of external rotation showed no difference between the two groups.Kaplan-Meier analysis showed that there were significant differences in the recurrence rate of instability between the two groups.Conclusion Arthroscopic modified Remplissage procedure is effective for treating recurrent traumatic anterior shoulder instability with Hill-Sachs lesion and improves the stabilization of shoulder without affecting of range of motion.