分析讨论切开Latarjet手术治疗复发性肩关节前脱位的疗效。

采用回顾性病例系列研究分析2016年12月至2022年3月符合复发性肩关节前脱位伴肩盂缺损条件的患者，术前记录患侧肩关节功能（前屈上举、体侧外旋、外展90°外旋、内旋），手术通过三角肌胸大肌入路运用Latarjet技术进行重建治疗肩关节复发性前脱位共16例。术后通过门诊随访、电话随访、微信视频随访等方式收集美国肩肘外科协会评分（American shoulder elbow surgeons'form, ASES）、Constant-Murley肩关节功能评分、美国加州大学肩关节评分表（University of California at Los Angeles shoulder rating scale, UCLA）、视觉模拟评分法（visual analogue scale，VAS）以及记录术后肩关节功能，评估患者肩关节疼痛、活动度、肌力及稳定性等情况。

符合纳入条件患者共16例（随访截至2022年6月），随访4~42个月，平均（27.25±16.43）个月。术后切口均Ⅰ期愈合，无血管、神经损伤等，随访期间，患者无再次脱位发生，肩关节恐惧试验均（-）。其中1例患者术后复查CT见移植骨块吸收，出现纤维愈合（愈合率93%）。末次随访时：ASES评分区间为78.3~100分，平均（89.44±7.59）分（良4例、优12例，评分90分及以上共9例）。Constant-Murley评分区间为89~100分，平均（95.50±2.73）分（优16例，其中>95分4例、90~95分11例、<90分1例）。UCLC评分区间为33~35分，平均（33.63±0.96）分（良11例、优5例）。VAS评分区间为0~2分，平均（1.38±0.96）分。末次随访患者肩关节功能：前屈上举由术前158.75°±4.65°上升至165.00°±4.83°，差异有统计学意义（P<0.01）；体侧外旋由术前58.75°±3.42°下降至56.56°±4.37°，差异有统计学意义（P<0.01）；外展90°外旋由术前80.00°±3.65°下降至77.81°±3.64°，差异有统计学意义（P<0.05）；内旋由术前6.38°±1.63°上升至8.13°±1.82°，差异有统计学意义（P<0.01）。患者随访提示：Latarjet术后患肢外展、外旋功能较前下降，前屈、内旋功能较术前改善。

切开Latarjet手术治疗复发性肩关节前脱位疗效肯定。中期随访效果令人满意。

The shoulder joint (glenohumeral joint) is one of the body's most unstable and frequently dislocated joints from the anatomical and biomechanical characteristics, accounting for about 50% of all joint dislocations. The incidence rate among the general population is about 2%. Shoulder joint instability means that patients repeatedly experience Shoulder joint dislocation, subluxation, or fear of joint prolapse during Shoulder joint activities. It is divided into traumatic Shoulder joint instability and non-traumatic Shoulder joint instability. Traumatic Shoulder joint instability is more common, and most are accompanied by pathological changes such as Shoulder joint bone injury or glenoid lip, Joint capsule ligament injury, or rotator cuff injury. No anatomical healing is obtained after the first dislocation. In the classification, anterior instability of the Shoulder joint is the most common. The first dislocation occurred in patients under ten years old. After Conservative management, the rate of Shoulder joint dislocation was 100%, 94% for patients aged 20-30, and 50% for patients aged 30-40. The curative effect of rehabilitation treatment on Shoulder joint dislocation caused by different reasons was that the cure rate for post-traumatic recurrent Shoulder joint dislocation was only 16%. The method of treating recurrent anterior dislocation of the Shoulder joint has been constantly improved and updated in practice. At present, there are many surgical methods in clinical use.

To analyze and discuss the effect of open Latarjet operation for recurrent anterior dislocation of the shoulder joint.

A retrospective case series study was conducted to analyze patients with recurrent anterior dislocation of the shoulder with shoulder pelvis defect from December 2016 to March 2022. The function of the affected shoulder joint was recorded before surgery (forward flexion and upward lift, lateral external rotation, 90° external rotation, and internal rotation with abduction) . Sixteen cases of recurrent anterior dislocation of the shoulder joint were reconstructed by the deltoid pectoralis major approach using the Latarjet technique. Postoperative shoulder function was recorded utilizing "outpatient follow-up, telephone follow-up, and WeChat video follow-up," including American society for shoulder and elbow surgery scores (ASES) , Constant-Murley shoulder function scores, UCLA shoulder rating scale, and VAS scores. The patient's shoulder pain, range of motion, muscle strength, and stability were evaluated.

The follow-up was up to March 2022, and 16 patients qualified for inclusion were followed up for 4-42 months with an average of (27.25±16.43) months. ASES: The scoring range is 78.3-100 points, with an average of (89.44±7.35) points. Constant-Murley: The score range was 89-100 points, with an average of (95.50±2.73) points. UCLC: The scoring range was 33-35 points with an average of (33.63±0.96) points. VAS: The score range was 0-2 points, with an average of (1.38±0.96) points. At the last follow-up, the shoulder joint function of patients increased from preoperative (158.75°±4.65° to 165.00°±4.83°) with statistical significance (P<0.01) . The lateral rotation decreased from 58.75°±3.42° to 56.56°±4.37° before operation (P<0.01) . The abduction of 90° was dropped from 80.00°±3.65° to 77.81°±3.64° before the procedure (P<0.05) . Internal rotation increased from 6.38°±1.63° to 8.13°±1.82°. The difference was statistically significant (P<0.01) .

Open Latarjet operation effectively treats recurrent anterior dislocation of the shoulder joint. The results of the mid-term follow-up were satisfactory.