关节镜下导航引导双袢固定的Eden-Hybbinette手术治疗复发性肩关节脱位

doi:10.3877/cma.j.issn.2095-5790.2025.03.002

目的

探讨肩关节Bankart损伤的诊断与治疗，研究关节镜下导航引导双袢固定的自体髂骨移植（Eden-Hybbinette手术）治疗复发性肩关节脱位合并关节盂骨缺损的技术方法及早期的临床结果。

方法

通过文献阅读总结和归纳Bankart损伤的诊断与治疗。并收集了2021年1月至2022年10月之间10例肩关节前向不稳合并关节盂骨严重缺损的患者行关节镜下导航引导双袢固定的Eden-Hybbinette手术。术后所有患者都进行了至少18个月以上的随访，对比患者术前美国肩肘外科协会评分（American shoulder and elbow surgeons scale, ASES）、Rowe评分来评价肩关节功能的改善情况，使用量角器测量出肩关节的活动度，并通过术后CT数据采用Mimics软件重建出肩关节的三维模型，评价自体髂骨移植物的愈合、位置、骨吸收。

结果

所有患者均获得随访，术前、术后6个月、术后12个月、术后18个月ASES评分分别为60.6分、82.2分、89.4分、90.8分，Rowe评分分别为35.5分、85.5分、87分、90分，可以看到从6个月开始到末次随访的18个月，ASES评分和Rowe评分显著提升, P<0.05差异具有统计学意义。术后CT显示骨块固定牢固，虽然出现一定的骨吸收，但是骨块和关节盂已经出现愈合，骨折线消失并且骨块整体塑形良好，所有患者均未出现骨块固定不牢固、关节间隙变窄等临床并发症，总体治疗效果满意。

结论

关节镜下导航引导双袢固定的Eden-Hybbinette手术对治疗肩关节前向不稳合并关节盂严重骨缺损早期临床效果良好。

关键词: 肩关节前向不稳, 肩关节脱位, 关节盂骨缺损, 髂骨移植, 关节镜下Eden-Hybbinette术

Background

The shoulder joint is the most flexible in the human body and has an extensive range of motion, so the human shoulder joint is easy to be injured. The stability of the shoulder joint is mainly maintained through the dynamic and static structures of the shoulder joint, and the maintenance of the two structures keeps the shoulder joint in a fixed position. Dynamic parts include the muscles and tendons around the shoulder joint, including the rotator cuff, allowing the shoulder joint to move in different directions. The static structure consists of the inherent anatomy of the shoulder joint, the surrounding ligaments, and the glenoid lip of the shoulder joint. The glenoid lip of the shoulder is a fibrocartilaginous tissue that surrounds the edge of the glenoid and helps stabilize the humeral head during displacement. Shoulder dislocation is common, primarily anterior dislocation, which often occurs in young people with a lot of exercise. High-energy trauma can cause the failure of the anterior static structure, and most of them are traumatic dislocations. Frequent dislocation will develop into recurrent dislocation, often leading to shoulder glenoid labial tear (Bankart injury) , the most common cause of recurrent shoulder dislocation. With the improvement of living standards and sports demand, the incidence of Bankart injury increases. If treatment is delayed or improper, the recurrence rate is high, so the treatment of Bankart has significant clinical value. Shoulder dislocation combined with glenoid defect and surgical method selection are challenging, and arthroscopic iliac bone grafting has a long learning curve and requires doctors with rich experience, so it is difficult to carry out in all sports medicine disciplines.

Objective

To investigate the diagnosis and treatment of shoulder Bankart injury and to study the technique and early clinical results of treating recurrent shoulder dislocation combined with glenoid defect using double loops autogenous bone grafting (Eden-Hybbinette procedure) under arthroscopy.

Methods

A literature review summarized the diagnosis and treatment of Bankart injury. Ten patients with anterior shoulder instability combined with severe glenoid defect underwent the Eden-Hybbinette procedure with arthroscopic navigation and double loop fixation between January 2021 and October 2022. All patients were followed up for at least 18 months after surgery. The improvement of shoulder joint function was evaluated by comparing patients' ASES scores and Rowe scores before surgery. A protractor measured the range of motion of the shoulder joint, and the three-dimensional model of the shoulder joint was reconstructed by Mimics software through postoperative CT data. The healing, position, and bone resorption of autogenous iliac bone grafts were evaluated.

Results

All patients were followed up. Before surgery, 6 months after surgery, 12 months after surgery, and 18 months after surgery, ASES scores were 60.6, 82.2, 89.4, and 90.8, respectively. Rowe's scores were 35.5, 85.5, 87, and 90, respectively. From the beginning of 6 months to the last follow-up of 18 months, the ASES score and Rowe score were significantly improved, and the difference was statistically significant with a P<0.05. Postoperative CT showed that the bone mass was firmly fixed, and although there was some bone resorption, the bone mass, and glenoid had healed, the fracture line disappeared, and the overall shape of the bone mass was good. No clinical complications, such as unstable bone mass fixation and joint space narrowing, occurred in all patients, and the overall treatment effect was satisfactory.

Conclusion

The Eden-Hybbinette procedure with double loop fixation under arthroscopic guidance has good early clinical results in treating anterior shoulder instability combined with severe glenoid bone defect.

Key words: Anterior shoulder instability, Shoulder dislocation, Glenoid bone defect, Iliac bone grafting, Arthroscopic Eden-Hybbinette procedure

图1 采取肩关节的后入路进入盂肱关节　图A：术中肩关节镜下见肩胛盂骨严重缺损，肩关节处于脱位或半脱位状态；图B：术中肩关节镜下可见关节盂缺损的前方大量塌陷的软组织和少量骨块

图2 将定位器从后方入路放置于关节盂后方注：a为术中等离子刀在肩胛盂中下三分之一的位置标记点；b为定位器顶端对准等离子标记的点

图3 将定位器从体外推至关节盂表面　图A：用2.5 mm的克氏针将关节盂下方打穿，准备用钢丝过线；图B：术中将骨块送至关节盂缺损的位置；图C：行Bankart修复术将骨块关闭至关节囊外

图4 用定位器导航引导下用2.5 mm的克氏针将关节盂下方打穿　图A：关节盂俯视图；图B：关节盂前方视图；图C：定位器剖面图

图5 把袢钢板上的两根缝线从中间孔径穿出，1、2两根线用于固定骨块，3、4两根线用于骨块防旋

图6 术前、术后6个月、12个月以及18个月的ASES评分（图A）、Rowe评分（图B）注：ASES为美国肩肘外科协会

表1 术前与末次随访ASES、Rowe评分比较（分，

±s）

时间	ASES评分	Rowe评分
术前	60.6±3.8	35.5±9.3
术后6个月	82.2±3.8	85.5±9.3
术后12个月	89.4±3.8	87.0±8.6
术后18个月	90.8±3.5^a	90.0±5.8^a

表1 术前与末次随访ASES、Rowe评分比较（分，

±s）

时间	ASES评分	Rowe评分
术前	60.6±3.8	35.5±9.3
术后6个月	82.2±3.8	85.5±9.3
术后12个月	89.4±3.8	87.0±8.6
术后18个月	90.8±3.5^a	90.0±5.8^a

图7 术后CT　图A:术前三维重建；图B:术后三维重建；图C：术后2年三维重建；图D:术前CT平扫；图E：术后CT平扫：图F：术后2年CT平扫

图8 术后骨隧道和关节盂表面的成角和距离　图A：骨隧道和关节盂表面的成角为0°，基本处于平行状态；图B：骨隧道与关节盂表面的距离为4.5 mm

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Arthroscopic navigation-guided Eden-Hybbinette procedure of double loop fixation for the treatment of recurrent shoulder dislocation

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Arthroscopic navigation-guided Eden-Hybbinette procedure of double loop fixation for the treatment of recurrent shoulder dislocation