关节镜下带线锚钉修补术治疗Ⅴ型SLAP损伤临床观察

doi:10.3877/cma.j.issn.2095-5790.2023.03.005

目的

探讨关节镜下带线锚钉修补术治疗Ⅴ型由前至后盂唇（superior labral anterior to posterior，SLAP）损伤的手术技术并观察临床疗效。

方法

回顾性分析2013年1月至2018年6月共12例Ⅴ型SLAP损伤患者，采用关节镜下带线锚钉技术修补盂唇，术后随访1年，手术前后采用疼痛视觉模拟评分（visual analogue scale，VAS）、关节活动度（range of motion，ROM）、Rowe评分和美国肩肘协会评分（American shoulder and elbow surgeons, ASES）等评估手术效果。

结果

12例患者VAS评分术前和术后6个月、术后1年相比差异均有统计学意义（P<0.05）。ROM（外旋）术后6个月与健侧相比差异具有统计学意义（P<0.05），术后1年与健侧相比差异无统计学意义（P>0.05）。Rowe和ASES评分术前和术后1年相比差异均有统计学意义（P<0.05）。

结论

关节镜下带线锚钉修补手术治疗Ⅴ型SLAP损伤能够改善患者肩关节疼痛和功能，具有良好临床疗效。

关键词: 关节镜, Ⅴ型SLAP损伤, 盂唇修补, 临床疗效

Background

Superior labral anterior to posterior (SLAP) injury is a lesion of the upper lip of the shoulder joint that often causes pain or even instability in the shoulder joint during specific movements. In 1990, Snyder divided the upper glenoid lip injuries into four types based on the injuries described by Andrews and named them SLAP injuries. The most common type II injury was the avulsion of the upper glenoid lip and the long head tendon of the biceps muscle from the glenoid pelvis. In 1995, Maffet et al. added three SLAP injuries to the Snyder classification, totaling seven types of injuries. Bankart injury is an avulsion injury in the anterior and inferior glenohumeral ligament complex of the shoulder glenoid and labial. According to the classification of Maffet, type V SLAP injury refers to the continued upward extension of the Bankart injury and the separation of the LHB stop, that is, type II SLAP injury combined with Bankart injury. The incidence of type V SLAP injuries is about 4%-15% of all SLAP injuries, and Gartsman believes that the incidence of type V SLAP injuries in chronic forward shoulder instability is about 57%. Compared with Type II SLAP injury and Bankart injury surgery, Type V SLAP injury surgery requires the management of both anterior labial and upper labial biceps tendon complex tears, more extensive tear repair and insertion of more anchors, more line crosses, and management of multiple sutures, and requires more technical requirements. In addition, the implant site or the crossing site of the anchor is not appropriate, which may lead to too tight suture, leading to external rotation of the shoulder joint after surgery.

Objective

To investigate the surgical technique and clinical efficacy of arthroscopic suture anchor repair for type Ⅴ SLAP injury.

Methods

A total of 12 patients with type Ⅴ SLAP injury from January 2013 to June 2018 were retrospectively analyzed, and their labral injuries were repaired with suture anchor under arthroscopy. They were followed up for 1 year after surgery. The visual analogue scale, range of motion, Rowe score and ASES score were used to evaluate the surgical effect.

Results

The VAS scores of 12 patients 6 months and 1 year after surgery were statistically different before surgery (P<0.05) . The ROM of external rotation 6 months after surgery was statistically different compared with the unaffected side (P<0.05) but not statistically significant compared with the unaffected side 1 year after surgery (P>0.05) . The scores of Rowe and ASES before surgery were statistically different from 1 year after surgery (P<0.05) .

Conclusion

Arthroscopic suture anchor repair for type Ⅴ injury can attenuate shoulder pain and improve function with good clinical efficacy.

Key words: Arthroscopy, Type Ⅴ SLAP injury, Labral repair, Clinical efficacy

图1 带线锚钉修复右肩5~11点区域V型SLAP损伤　图A：1枚带线锚钉放置于12点位置修复LHB-盂唇复合体；图B：修复Bankart损伤的第1枚锚钉放置于5点钟方向；图C：修复Bankart损伤的第2枚锚钉放置于3点半钟方向；图D：修复Bankart损伤的第3枚锚钉放置于2点钟方向注：SLAP为由前至后盂唇；LHB为肱二头肌长头腱

图2 带线锚钉修复左肩6~12点区域V型SLAP损伤　图A：盂唇撕裂涉及6点钟方向；图B-C：后外下入路于6点钟方向置入锚钉并过线；图D：打结固定撕裂的盂唇和腋囊注：SLAP为由前至后盂唇

图3 带线锚钉固定V型SLAP损伤　图A：褥式缝合固定Bankart损伤；图B：Bankart损伤处打结后LHB-盂唇复合体打结固定注：SLAP为由前至后盂唇；LHB为肱二头肌长头腱

图4 置钉、缝合及打结过程　图A：12点位置置钉过线，不打结；图B：前方置钉及过线；图C：自下而上打结；图D：最后12点方向打结

表1 Ⅴ型SLAP损伤术前和术后的功能评分表（n=12）

时间	VAS评分（分）	ROM 0°外旋（°）		Rowe评分（分）	ASES评分（分）
时间	VAS评分（分）	术侧	健侧	Rowe评分（分）	ASES评分（分）
术前	4.00（4.00，5.00）	92.50（86.25，107.75）	53.50（48.75，58.25）	45.00（45.00，55.00）	36.43（28.70，38.95）
术后6个月	2.00（1.25，3.00）^a	40.50（34.50，46.75）^a,c		92.50（82.50，95.00）^a	78.59（64.91，82.99）^a
术后1年	0.50（0.00，1.00）^a,b	55.50（40.60，67.50）^a,b,d		92.50（90.00，95.00）^a,e	83.23（73.30，87.65）^a,e

表1 Ⅴ型SLAP损伤术前和术后的功能评分表（n=12）

时间	VAS评分（分）	ROM 0°外旋（°）		Rowe评分（分）	ASES评分（分）
时间	VAS评分（分）	术侧	健侧	Rowe评分（分）	ASES评分（分）
术前	4.00（4.00，5.00）	92.50（86.25，107.75）	53.50（48.75，58.25）	45.00（45.00，55.00）	36.43（28.70，38.95）
术后6个月	2.00（1.25，3.00）^a	40.50（34.50，46.75）^a,c		92.50（82.50，95.00）^a	78.59（64.91，82.99）^a
术后1年	0.50（0.00，1.00）^a,b	55.50（40.60，67.50）^a,b,d		92.50（90.00，95.00）^a,e	83.23（73.30，87.65）^a,e

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Clinical observation of the treatment of type V SLAP injury with anchor repairment under arthroscope

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Clinical observation of the treatment of type V SLAP injury with anchor repairment under arthroscope