During epileptic seizures, a series of injury caused by the fall event as a result of muscle spasms has always been the therapeutic difficulty in clinical practice.From the perspective of orthopaedic doctor, the instability of shoulder joint caused by fall damage is the focus of our attention.It has been reported in literature that the incidence of shoulder dislocation caused by seizures is approximately 0.6%.Considering that a large number of patientsare missed, we believe that the actual incidence rate is much higher than this value.It has been previously thought that the posterior shoulder dislocation caused by strong muscle contraction in the patient with epilepsy is more common. However, the truth is that the proportion of patient with anterior shoulder dislocation is not low, and it is even reported that the incidence rates of anterior and posterior shoulder dislocationsare 50% and 50% respectively. Currently, there are many surgical methods for the treatment of anterior shoulder dislocation including soft tissue repair surgery and bone repair surgery. Among them, the Latarjet procedure in bone repair surgery is the most widely applied technique.Objective To explore the clinical efficacy of modified arthroscopic double-Endobutton Latarjet procedure for the treatment of recurrent anterior shoulder dislocation in epileptics.

From October 2014 to October 2016,a total of 9 epileptics (9 shoulder joints) suffered from anterior shoulder dislocation with severe bone defect received the modified arthroscopic double-Endobutton Latarjet procedure in our hospital. The mean age was (26.3±3.1) years old. All patients received anti-epileptic treatment for over half of a year before surgery, and the anti-epileptic treatment was continued for 1 year after operation.Immediate postoperative CT scan was performed to detect bone graft position.Then,CT scan was performed at the 3rd , 6th, 12th, and 24th months to evaluate the status ofbone graft absorption and union. The ASES score, Rowe score and Walch-Duplay score were recorded during each follow-up to assess patients’ shoulder function.

Eight patients were followed up for anaverage of (20.1±4.2) months, while 1 patient ofright shoulder was lostfor follow-up.Three patients had recurrent epilepsy 2 months, 6 months and 8 months after operation respectively due to absence of taking medicine.Among them,1 case was lost for follow-up atthe 6th postoperative month, and the remaining 2 patients with recurrence showed a significant displacement of bone graft and then healed again after conservative treatment. A total of 7 patients received complete follow-up, and the bone grafts healedduring the last followup. Six patients returned to competitive exercise, and 2 patients returned to normal life without complaint of shoulder joint instability.The CT scans showed significant difference of bone graft plasticity. The bone absorption rate in 4 cases was between 5% and 75%. Three cases had the area expanded compared to the original state, and 1 case had no obvious change.Before operation and during the last followup: the mean ASES scoreswere (76.75±7.41) points and (94.68±5.02) points respectively (P<0.05) ;the mean Rowe scores were (43.75±5.82) points and (93.13±5.30) points respectively (P<0.05) ; the mean Walch-Duplay scores were (76.13±6.98) points and (93.00±2.00) points respectively (P<0.05) .

The modified arthroscopic double-Endobutton Latarjet procedure has a good short-term clinical effect on epileptics with anterior shoulder dislocation, and this technique has the potential of reunion after recurrence.The patient satisfaction is high, and this technique is worth of promotion and application.However, we should pay more attention to the postoperative control of epileptic seizure and the prevention of epilepsy recurrence to avoidoperation failure and recurrent shoulder dislocation.