关节镜下双袢固定自体髂骨修复合并严重骨缺损的Bankart损伤临床疗效分析

目的 探讨关节镜下双袢固定自体髂骨修复合并严重骨缺损的Bankart损伤患者肩关节临床功能改善及肩胛盂骨缺损修复情况.方法 回顾性分析2015年7月至2018年7月在南方医科大学第三附属医院运动医学科采用关节镜下双袢固定自体髂骨植骨术治疗的17例合并严重骨缺损的Bankart损伤患者.在术前和术后使用美国肩肘外科协会(...

Clinical efficacy analysis of Arthroscopic double Endobuttons fixation of autologous iliac bone for the repair of Bankart lesion with severe bone defect

Background The osseous Bankart lesion is a common glenoid bone lesion of shoulder in clinical practice,which often causes anterior instability or even recurrent dislocation of the shoulder joint.With arthroscopic Bankart repair becoming the first choice for soft tissue injury in patients with anterior shoulder instability,the choice of arthroscopic treatment for patients with chronic glenoid bone defect has attracted more and more attention of surgeons.At present,arthroscopic reconstruction of glenoid cavity with Endobutton fixation of autologous iliac bone grafting has been applied in clinical practice,but there are still few studies on its postoperative efficacy.Objective To investigate the improvement of shoulder clinical function and glenoid bone defect repair in patients of Bankart lesion with severe bone defect repaired by arthroscopic double Endobutton fixation with autologous ilium bone grafting.Methods From July 2015 to July 2018,17 patients with Bankart injury of shoulder joint complicated with severe bone defect were treated with arthroscopic double Endobutton fixation and autologous iliac bone grafting in the department of sports medicine,the third affiliated hospital of southern medical university.The American shoulder and elbow surgeons (ASES) score,Constant-Murley score,Rowe score,and active range of motion of shoulder joint were measured preoperatively and postoperatively to assess the improvement of shoulder joint function,and the degree of postoperative bone defect repair was evaluated by three-dimensional CT.Results All 17 patients were followed up and the average age was 32.11 (17-71) years.No complications such as infection,traumatic arthritis or redislocation occurred during the period.The mean ASES score,Constant-Murley score and Rowe score in the 6th month,12th month and 24th month after operation were significantly higher than those before operation,and there were statistical differences (P<0.05).The scores in the 24th month were significantly higher than those in the 6th month after operation,and there was statistical difference (P<0.05).The mean ranges of motion of anteflexion and internal rotation was significantly increased in the 6th month,12th month and 24th month after operation,and there were statistical differences (P<0.05).The mean range of motion of external rotation,internal rotation at 90° of abduction and external rotation at 90° of abduction had no significant difference before and after operation (P>0.05).The average degrees of glenoid bone defect in the 6th month,12th month and 24th month after operation were significantly reduced,and there were statistical differences (P<0.05),and there was no significant difference in the 24th month compared with that in the 12th month after operation (P>0.05).In the 24th month after surgery,the CT scan demonstrated that each grafted bone fragment had fused with the glenoid cavity.Conclusion Arthroscopic double Endobutton fixation with autologous iliac bone grafting for the repair of Bankart injury with severe bone defect can improve the shoulder joint function with less bone resorption and good healing of the grafted bone fragment.No postoperative shoulder complications were observed during the follow-up period.The clinical effect of this treatment for Bankart injury with severe bone defect is good.