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中华肩肘外科电子杂志 ›› 2023, Vol. 11 ›› Issue (01) : 12 -17. doi: 10.3877/cma.j.issn.2095-5790.2023.01.003

论著

关节镜治疗肩关节复发性前脱位伴纤维性Bankart损伤的疗效研究
李朋1, 吴剑波1, 王东1, 赵峰1, 田伟1, 常峰1, 张宇明1,()   
  1. 1. 030012 太原,山西医科大学第五临床医学院骨科
  • 收稿日期:2022-09-12 出版日期:2023-02-05
  • 通信作者: 张宇明

The effect of arthroscopic treatment of recurrent anterior dislocation of the shoulder joint with fibrous Bankart injury

Peng Li1, Jianbo Wu1, Dong Wang1, Feng Zhao1, Wei Tian1, Feng Chang1, Yuming Zhang1,()   

  1. 1. Department of Orthopedics, the Fifth Clinical Medical College of Shanxi Medical University, Taiyuan 030012, China
  • Received:2022-09-12 Published:2023-02-05
  • Corresponding author: Yuming Zhang
引用本文:

李朋, 吴剑波, 王东, 赵峰, 田伟, 常峰, 张宇明. 关节镜治疗肩关节复发性前脱位伴纤维性Bankart损伤的疗效研究[J]. 中华肩肘外科电子杂志, 2023, 11(01): 12-17.

Peng Li, Jianbo Wu, Dong Wang, Feng Zhao, Wei Tian, Feng Chang, Yuming Zhang. The effect of arthroscopic treatment of recurrent anterior dislocation of the shoulder joint with fibrous Bankart injury[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2023, 11(01): 12-17.

目的

评价肩关节镜下行带线锚钉缝合修补盂唇术治疗肩关节复发性前脱位伴纤维性Bankart损伤的临床效果。

方法

回顾性分析本科自2019年7月至2021年7月采用肩关节镜下带线锚钉缝合修补盂唇术治疗肩关节复发性前脱位伴纤维性Bankart损伤的41例患者的临床资料和随访结果,其中男25例、女16例;年龄20~55岁,平均(30.4±5.5)岁;左侧13例、右侧28例;术前关节脱位次数为3~25次,平均(8.3±1.6)次。手术方式均为肩关节镜下带线锚钉缝合修补盂唇术。入组患者分别于术前1周和术后1、3、6、12个月随访并记录患肢外展90°时外旋角度值,前屈上举角度值,臂、肩、手残障评分(disability of the arm,shoulder and hand,DASH),Rowe评分及Constant-Murley评分。根据结果对其手术效果进行研究分析。

结果

针对符合条件的病例行临床资料分析和定期随访,随访病例肩关节术后都未复发脱位,均对手术效果满意。41例患者随访数据显示术前1周、术后12个月外展90°时外旋角度为(56.02±4.45)°和(86.02±2.59)°;前屈上举角度分别为(160.27±7.62)°和(175.68±3.39)°;DASH评分为(39.37±6.47)分和(10.76±2.84)分;Rowe评分为(40.73±7.38)分和(96.71±3.28)分;Constant-Murley评分为(76.44±4.06)分和(96.66±2.33)分,所得结果P值均<0.01,差异具有统计学意义。Constant-Murley分值较术前明显提高。

结论

肩关节镜下行带线锚钉缝合修补盂唇术治疗肩关节复发性前脱位伴纤维性Bankart损伤具有显著疗效,值得推广。

Background

Due to the extensive range of motion of the shoulder joint and the particular anatomical structure, the humerus head is prone to dislocation when moving. According to statistics, shoulder joint dislocation accounts for 1/2 of the total body joint dislocation. Long-term and repeated shoulder dislocation is the leading cause of shoulder joint pain and limited activity. After the initial dislocation, the anterior wall of the joint capsule, avulsion of the glenoid or glenoid margin, and posterior concave fracture of the humeral head in some patients were not repaired after reduction, and malunion occurred, leading to repeated dislocation, and previous dislocation was the most common. With the progress of arthroscopy technology and improvement of medical level, arthroscopy has advantages such as comprehensive observation of the injured site, high patient compliance, good postoperative appearance, etc., and shoulder arthroscopy has gradually become the preferred treatment for recurrent shoulder dislocation. Objective To retrospectively analyze and evaluate the efficacy of the suture repair of the glenoid labrum with suture anchor for recurrent anterior dislocation with fibrous Bankart injury.

Methods

Forty-one patients with recurrent anterior dislocation of the shoulder joint and fibrous Bankart injury who underwent suture repair of glenoid labrum under shoulder arthroscopy in the People's Hospital of Shanxi Province were enrolled, and the clinical data were analyzed.

Results

For eligible cases, regular follow-up was conducted for one year. No recurrent dislocations were observed in the following cases, and all patients were satisfied with the surgical outcome. Follow-up data for 41 patients showed that the external rotation angles were (56.02±4.45) ° and (86.02±2.59) ° one week before and 12 months after surgery, respectively. The flexion and abduction angles were (160.27±7.62) ° and (175.68±3.39) °, respectively. The DASH scores were (39.37±6.47) scores and (10.76±2.84) scores, the ROWE scores were (40.73±7.38) scores and (96.71±3.28) scores, and the Constant-Murley scores were (76.44±4.06) scores and (96.66±2.33) scores. All results had a P value less than 0.01 and were statistically significant.

Conclusion

The treatment of recurrent anterior dislocation of the shoulder joint with fibrous Bankart injury by arthroscopic suture repair of the glenoid labrum with the suture anchor has a significant effect.

表1 患者术前1周和术后1个月的相关指标资料(±s
表2 患者术前1周和术后3个月的相关指标资料(±s
表3 患者术前1周和术后6个月的相关指标资料(±s
表4 患者术前1周和术后12个月的相关指标资料(±s
表5 患者术前1周及术后1、3、6、12个月Constant-Murley评分系统各分段的数量和比例[例(%)]
图1 术后肩关节X线片
图2 术前MRI影像 图A:水平位T2加权;图B:冠状位T1加权
图3 手术入路
图4 术中盂唇损伤图
图5 盂唇缝合图
图6 术后肩关节功能评测 图A:前屈上举;图B:外旋;图C:内旋
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