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。

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（American shoulder and elbow surgeons,ASES）评分、Constant评分、Rowe评分量表并测量肩关节主动活动度以评估肩关节功能改善情况，在三维CT上评估术后骨缺损修复程度。

所有17例患者均完成随访，期间未出现感染、创伤性关节炎及再脱位等并发症。术后6个月、12个月、24个月平均ASES评分、Constant评分、Rowe评分均较术前显著增高，差异均具有统计学意义（P<0.05），各评分在术后24个月较术后6个月均显著增高，差异均具有统计学意义（P<0.05）。术后6个月、12个月、24个月平均前屈、体侧内旋活动度均较术前显著增大，差异均具有统计学意义（P<0.05）；平均体侧外旋、外展90°时内旋、外展90°时外旋活动度在手术前后差异均无统计学意义（P>0.05）。术后6个月、12个月、24个月时平均肩胛盂骨缺损程度均较术前显著降低，差异均具有统计学意义（P<0.05），术后24个月较术后12个月差异均无统计学意义（P>0.05）。术后24个月CT可见各移植骨块均已与肩胛盂融合。

关节镜下双袢固定自体髂骨修复合并严重骨缺损的Bankart损伤术后患者肩关节功能改善好，移植骨块骨吸收程度较少、愈合良好，随访期间未观察到肩部术后并发症，该术式治疗合并严重骨缺损的Bankart损伤临床效果良好。

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.

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.

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.

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.