锚钉固定位置与角度对肩关节前关节囊修复效果影响

目的探讨不同锚钉位置及角度对关节镜治疗复发性肩关节前向不稳临床疗效的影响。 方法回顾性分析85例于2018年1月至12月因复发性肩关节前向不稳在南部战区总医院接受肩关节镜手术治疗的患者排除严重骨缺损、翻修等其他损伤。使用术后肩关节CT测量锚钉位置及插入角度，采用视觉模拟评分系统(VAS评分)及Rowe评分系统对患者术后关节疼痛程度、稳定性、活动度及功能进行综合评价。不同锚钉位置及角度与VAS评分及Rowe评分的关系使用独立样本t检验分析。 结果在85例患者中，有57例患者的所有锚钉均在肩胛盂关节面上，28例患者的锚钉部分在肩胛盂关节面上，部分在肩胛盂边缘。两组的比较中，VAS评分差异无统计学意义(t ＝－0.829，P>0.05)；所有锚钉均在肩胛盂关节面上的患者Rowe评分较高(t＝－4.072，P<0.05)。通过术后Rowe评定分级对锚钉打入角度的反向比较中，2点、3点、4点和5点钟4个位点对应锚钉角度之间的比较均无统计学差异(t＝0.312、0.885、0.775、0.934，均为P>0.05)。 结论肩关节镜下缝合锚钉在合理插入角度范围内固定于肩胛盂边缘稍内侧的关节面上可以使复发性肩关节前向不稳的患者获得更好的近期疗效，而远期疗效需要进一步深入研究。

Effect of anchor fixation position and angle on repair of anterior capsule of shoulder

ObjectiveTo investigate different suture anchor placement and insertion angle affect efficacy of patients with anterior shoulder instability after arthroscopic Bankart repair. MethodsRetrospective analysis was performed on 85 consecutive patients who underwent surgery for Bankart lesions in General Hospital of Southern Theater Command of PLA from January to December 2018. Severe bone defects, revision and other injuries were excluded. Postoperative CT was used to measure suture anchors’ placement and angle. Visual analog scale(VAS) and Rowe scores were used to comprehensively evaluate joint pain, stability, range of motion(ROM) and function at the last follow-up(range, 12-24 months). Independent sample t test was used to analyze the relationship between different anchor positions and angles and VAS and Rowe scores. ResultsThe group with the anchor placed on the glenoid face contained 57 patients, and the group with anchor partially placed at the glenoid edge contained 28 patients. VAS calculated at follow-up showed no significantly difference between two groups (t=-0.829, P>0.05), but the group with the anchor placed on the glenoid face were better in Rowe scores (t=-4.072, P<0.05). In the reverse comparison of anchor insertion angle by postoperative Rowe scores, there was no statistically significant difference between the four corresponding anchor insertion angles at two-, three-, four- and five-o’clock positions respectively(t=0.312, 0.885, 0.775, 0.934 respectively, all P>0.05). ConclusionSuture anchor positioned on the glenoid face with reasonable insertion angle can achieve better short-term efficacy after arthroscopic Bankart repair, and the long-term efficacy needs to be further studied.