复杂性肩关节脱位术后功能分析

doi:10.3877/cma.j.issn.2095-5790.2021.02.009

目的

探讨复杂性肩关节脱位术后不同类型的合并损伤对肩关节功能的影响。

方法

回顾性收集2015年1月至2017年12月北京大学人民医院收治的32例复杂性肩关节脱位患者的病例资料。分析因素包括年龄、性别、受伤方式、合并损伤类型及手术方式。

结果

肩关节脱位合并单纯肱骨大结节骨折行手术治疗组（n=8）末次随访时视觉模拟评分（visual analogue scale，VAS）为（0.75±0.71）分，保守治疗组（n=6）VAS评分为（3.33±1.03）分，两组间差异具有统计学意义（P<0.01）。美国肩肘外科协会评分（American shoulder and elbow surgeons, ASES）手术治疗组（78.75±11.11）分，保守治疗组（64.17±11.63）分，两组间差异具有统计学意义（P=0.04）。26例肩关节脱位伴合并损伤的患者术前VAS评分、ASES评分及Constant-Murley评分分别为（5.19±0.98）分、（46.38±5.70）分、（43.65±5.83）分，手术治疗合并损伤后，末次随访时评分分别为（0.54±0.58）分、（80.00±8.87）分、（74.54±12.76）分，手术前后差异均具有统计学意义（P<0.01）。多元线性回归分析提示合并损伤在手术修复后对功能评分的影响差异无统计学意义。

结论

手术治疗复杂性肩关节脱位合并损伤可改善肩关节功能，恢复关节稳定性。

关键词: 复杂性肩关节脱位, 大结节骨折, 肩袖损伤, Bankart损伤

Background

Shoulder dislocation is often caused by excessive abduction and external rotation of the upper arm. Anterior shoulder dislocation may be accompanied with axillary nerve injury, labrum avulsion (Bankart injury) , glenoid fracture (bony Bankart injury) , rotator cuff tear and humeral head compression fracture (Hill-Sachs injury) or greater tuberosity fractures, and dislocation accompanied with other injuries can be defined as complex shoulder dislocations. With the further understanding of shoulder joint dislocation, the rate of accompanied injuries has also increased. Studies have shown that early repair of the accompanied injuries was beneficial to restore shoulder joint stability.

Objective

To investigate the association between complicated injury types and shoulder function of patients with shoulder dislocation.

Methods

We retrospectively retrieved the data of 32 patients with complicated shoulder dislocation from January 2015 to December 2017. Preoperative factors included age, gender, mechanisms of injury, associated injury types and surgical approaches.

Results

Among patients with isolated greater tuberosity fracture, the VAS scores in the surgery (n=8) and conservative group (n=6) were 0.75±0.71 and 3.33±1.03, respectively, with statistically significant difference (P<0.01) . The ASES scores in the surgery (n=8) and conservative group (n=6) were 78.75±11.11 and 64.17±11.63, respectively, with statistical difference (P=0.04) . Preoperative VAS, ASES and CM scores were 5.19±0.98, 46.38±5.70, and 43.65±5.83, respectively, and postoperative score were 0.54±0.58, 80.00±8.87, and 74.54±12.76, respectively. The differences were statistically significant (P<0.01) . Multivariable linear regression analysis demonstrated that none of the injuries had association with shoulder function after operation.

Conclusion

Surgical repair of dislocation associated injuries can improve shoulder function and restore joint stability.

Key words: Complicated shoulder dislocation, Greater tuberosity fracture, Rotator cuff tear, Bankart lesion

表1 急性脱位合并单纯大结节骨折行手术与保守治疗的肩关节功能比较（分，±s）

组别	例数	VAS评分	ASES评分	Constant-Murley评分
手术治疗组	8	0.75±0.71	78.75±11.11	71.88±17.42
保守治疗组	6	3.33±1.03	64.17±11.63	72.17±10.36
t值		5.29	4.03	0.72
P值		<0.01	0.04	0.97

表1 急性脱位合并单纯大结节骨折行手术与保守治疗的肩关节功能比较（分，±s）

组别	例数	VAS评分	ASES评分	Constant-Murley评分
手术治疗组	8	0.75±0.71	78.75±11.11	71.88±17.42
保守治疗组	6	3.33±1.03	64.17±11.63	72.17±10.36
t值		5.29	4.03	0.72
P值		<0.01	0.04	0.97

表2 手术前后肩关节疼痛及功能评分比较（分，±s）

时间	VAS评分	ASES评分	Constant-Murley评分
术前	5.19±0.98	46.38±5.70	43.65±5.83
术后	0.54±0.58	80.00±8.87	74.54±12.76
t值	10.12	8.56	6.27
P值	<0.01	<0.01	<0.01

表2 手术前后肩关节疼痛及功能评分比较（分，±s）

时间	VAS评分	ASES评分	Constant-Murley评分
术前	5.19±0.98	46.38±5.70	43.65±5.83
术后	0.54±0.58	80.00±8.87	74.54±12.76
t值	10.12	8.56	6.27
P值	<0.01	<0.01	<0.01

表3 多因素分析不同类型合并损伤对肩关节ASES评分的影响

	B值	t值	P值	95%CI
性别	0.99	0.21	0.84	-8.70，10.69
年龄	-0.20	-1.14	0.27	-0.55，0.16
肩袖损伤	2.17	0.51	0.62	-6.62，10.97
Bankart损伤	0.50	0.09	0.93	-11.02，12.03
肱骨大结节骨折	-8.78	-1.58	0.13	-20.16，2.61

表3 多因素分析不同类型合并损伤对肩关节ASES评分的影响

	B值	t值	P值	95%CI
性别	0.99	0.21	0.84	-8.70，10.69
年龄	-0.20	-1.14	0.27	-0.55，0.16
肩袖损伤	2.17	0.51	0.62	-6.62，10.97
Bankart损伤	0.50	0.09	0.93	-11.02，12.03
肱骨大结节骨折	-8.78	-1.58	0.13	-20.16，2.61

表4 多因素分析不同类型合并损伤对肩关节Constant-Murley评分的影响

	B值	t值	P值	95%CI
性别	0.79	0.15	0.89	-10.37，11.95
年龄	0.10	0.50	0.62	-0.31，0.51
肩袖损伤	0.40	0.02	0.08	-9.72，10.52
Bankart损伤	1.47	0.23	0.82	-11.79，14.73
肱骨大结节骨折	-8.10	-1.27	0.22	-21.21，5.00

表4 多因素分析不同类型合并损伤对肩关节Constant-Murley评分的影响

	B值	t值	P值	95%CI
性别	0.79	0.15	0.89	-10.37，11.95
年龄	0.10	0.50	0.62	-0.31，0.51
肩袖损伤	0.40	0.02	0.08	-9.72，10.52
Bankart损伤	1.47	0.23	0.82	-11.79，14.73
肱骨大结节骨折	-8.10	-1.27	0.22	-21.21，5.00

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Functional analysis of complicated shoulder dislocation after surgical repair

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Functional analysis of complicated shoulder dislocation after surgical repair