创伤性复发性肩关节前脱位的关节镜检查和手术治疗

目的 利用关节镜观察创伤性复发性肩关节前脱位的病理类型和病变程度,为手术方法的选择提供依据,探讨改良Bristow术式和镜下Bankart重建术的临床疗效. 方法 回顾性研究1997年7月～2007年10月,创伤性复发性肩关节前脱位患者62例,其中男44例,女18例;年龄21～67岁.平均39.8岁.术前脱位痫程平均87个月.手术中先行肩关节镜检查,根据镜下观察关节脱位的病理类型、病变程度如:有无肩盂、肱骨头骨性缺损、Bankart 损伤程度和关节囊盂肱切带松弛等病变分别行政良Bristow手术或关节镜下缝合锚Bankart 重建术.疗效评估用加州大学洛杉矶分校(UCLA)功能评分. 结果 行改良Bristow手术45例,关节镜下缝合锚Bankaa重建术17例.,术后平均随访64.2个月,术前与术后平均UCLA评分分别为22.6±4.4和29.8±4.2(P＜0.01),肩关节前屈上举分别为(136.8±14.2).和(156.6±17.8).(P＜0.01),外展90°位外旋(52,5±16.4)°和(72.4±11.3)°(P＜0.01).终末随访时所有患者均未发生术后再次脱位,术后恐惧试验阳性6例(9.6%),其中60例(97%)患并恢复术前工作.所有患者被问及若健侧肩关节出现相同疾病时.都愿意接受相同手术治疗. 结论 利用关节镜观察创伤性复发性肩关节前脱位的病理改变及病因,为选择适当的手术方法提供参考.清晰处理肩关节不稳定病变原因、重建肩关节解削结构,恢复关节的稳定性,掌握好不同手术方法的指征,无论是改良Bristow手术方法还是镜下缝合锚Bankart 重建术都应是治疗复发性肩关节前脱位的有效方法.

Arthroscopic observation and surgical treatment of traumatic recurrent anterior dislocation of the shoulder

Objective To observe the pathologic type and degree of traumatic recurrent anterior dislocation of the shoulder by means of arthroscopy and discuss clinical results of modified Bristow method and arthroscopic Bankart reconstruction so as to provide refeFences for selecting operation methods.Methods A retrospective study was done off 62 patients(62 shoulders,44 males and 18 females.at av-erage age of 39.8 years.ranging from 21 to 67 years)with anterior recurrent dislocation of shoulder (mean duration of 87 months)admitted into our hospital from July 1997 to Oetcher 2007.All patients un-derwent preoperative arthroscopic examination that showed pathologic changes including injury of shoulder and humerus head,Bankart injury severity and laxitas of humerus glenoid ligament of articular capsule,which were used as referenee of surgical procedures.Modified Bristow's method or arthroscopic suture anchor Bankart reconstruction were performed according to arthroscopic results(pathologic change).The patients were assessed with the University of California at Los Angeles(UCLA)shoulder rating scale.Results There were 45 patients treated with modified Bristow,s method and 17 with arthroscopic suture anchor Bankart reconstruction.The follow.uD for mean 64.2 months showed that pre-and post-operative mean UCLA scores were(22.6±4.4)points and(29.8±4.2)points respectively(P＜0.01),the mean forward flexion(136.8±14.2)°and(156.6±17.8)°respectively(P＜0.01)and the mean ex-ternal rotation in 90°abduction(52.5±16.4)°and(72.4±11.3)°(P＜0.01).There were no redis-location at final follow-up,but there were 6 patients(9.6%)with positive apprehension test.Of all,60 patients(97%)returned to their pre-injury.work. Conclusions Observation of pathologic change of surgical procedure.Both modified Bristow's method and arthruscopic Bankart reconstruction are good methtxts for treatment of recurrent anterior shoulder dislocation under conditions of successful management of pathologic change of shoulder, restoration of normal anatomic structure of shoulder ioint and strict indi-cation control.