关节镜下手术治疗创伤性肩关节前不稳定

目的探讨关节镜下手术治疗创伤性肩关节前不稳定的治疗原则、操作要点以及临床效果。方法2002年9月至2005年5月,本组患者18例,其中运动伤12例,工伤5例,交通伤1例。受伤至就诊时间平均15周。临床表现为肩痛18例,肩活动受限15例。前惧痛征(apprehension)阳性18例;肱二头肌牵拉征(speed)阳性5例;X线出现Hill-Satchs征3例。气-碘双重对比造影CTⅠ度1例,Ⅱ度15例,Ⅲ度2例。手术情况镜下见前盂唇撕脱18例,前关节囊松弛4例,合并上方盂唇撕裂(SLAP损伤)4例,游离体3例,盂唇骨赘形成2例,肱骨头、肩胛盂软骨剥脱2例;分别给予关节镜下前盂唇缝合锚钉固定(18例),前关节囊松弛紧缩术(3例),肱二头肌腱刨削(2例),关节囊外重新附着固定(2例),上盂唇缝合(3例),刨削(1例)等处理。术前UCLA肩关节评分(14±3)分。结果18例患者平均随访18个月(10~32个月)。所有患者肩部疼痛消失。1例于剧烈活动后肩部酸困感。肩部活动受限3例,其中后伸受限10°1例,肩外旋受限2例(<20°),前惧痛征1例有轻度不适,余体征均为阴性。所有患者恢复原工作、运动。术后UCLA肩关节评分(32±5)分,与术前比较差异有统计学意义(t=14.081,P<0.01)。结论关节镜下治疗创伤性肩关节前不稳定可取得良好效果。熟练操作技术,准确判定前盂唇充分松解及复位、固定,并正确处理合并损伤十分重要。带线锚钉固定前盂唇可靠,操作简便。

Arthroscopic surgery on traumatic anterior instability of shoulder

OBJECTIVE: To study the principle of arthroscopic surgery and its clinical importance on the traumatic anterior shoulder instability. METHODS: From September 2002 to May 2005, 18 patients with injury history of 15 weeks averagely, were involved in the study. Twelve of the patients had a history of sports injuries, 5 had shoulder injuries during working time, and 1 had a traffic accident. Among them, 18 had shoulder pain, 15 had limitation of range of motion (ROM) of shoulder, 18 had positive apprehension test and 5 had positive speed test. Three patients had Hill-Satch lesion in X-ray. Double contrast CT: I degree: 1; II degree: 15; III degree: 2. On arthroscopic view, 18 had anterior glenoid labrum detachment, 4 had anterior capsular laxity, 4 had combined superior labral anterior posterior (SLAP) injury, 3 had free body, 2 had humeral head or glenoid cartilage lesion. Anterior glenoid labrum detachment in 18 patients was reduced and sutured by the fixed anchor technique, 3 had anterior capsule shrinkage, 2 had debridement of frayed long head tendon of biceps, and 2 had reattachment of the long head tendon of biceps outside the capsule. SLAP injuries were sutured in 3 and debridement of frayed superior labrum in 1. RESULTS: All of the patients were followed up with an average of 18 months (10 - 32 months). All the patients felt free of the pain of their shoulder, except one felt shoulder aching after strenuous exercise. The loss of the external-rotation of the operated shoulder was less than 20 degrees in 2 patients and the posterior extension was 10 degrees in 1 patient. One patient had a positive result of Apprehension Sign. UCLA score: 14 +/- 3 preoperatively, 32 +/- 5 postoperatively (t = 14.081, P < 0.01). All patients retured to preinjuried sports activities and original work. CONCLUSIONS: Traumatic anterior shoulder instability can obtain good effects when treated with the arthroscopic surgery of shoulder. Complete reduction, and reliable fixation of the arterior glenoid labrum complex is the key point. Fixation with the suture anchor is reliable and makes the operation simple.