创伤性肩关节前不稳定的诊断与治疗

Diagnosis and treatment of traumatic anterior instability of shoulder

目的:探讨创伤性肩关节前不稳定患者的临床诊断、治疗原则。方法:52例患者根据临床症状、体征,肩X线片,气、碘双重造影CT提供的信息,确定创伤性肩关节不稳定的诊断;根据病程,盂唇损伤、关节囊撕裂、松弛程度,选择治疗方法:1.病程在3个月以内,关节囊无或者轻度撕裂,采用康复治疗。2.病程3个月以上,或康复治疗后症状无缓解、甚至加重,或关节囊明显撕裂,采用前关节囊修复成形术治疗。结果:本组病例平均随访21个月,康复治疗组3例剧烈活动后肩部不适,2例后伸受限20°,4例无效改行手术治疗;手术治疗组1例后伸活动受限20°,其余病例症状消失,关节活动度正常。结论:创伤性肩关节前不稳定的诊断应结合病史、症状、体征、气碘双重造影CT全面分析。康复治疗适用于病程短,关节囊完整的患者。前关节囊修复成形术后,关节功能恢复较传统的肩胛下肌腱移位重叠术完善。

To study clinical diagnosis and treatment of traumatic anterior instability of shoulder. Methods: 52 patients were diagnosized as traumatic anterior instability of shoulder according to their symptom, clinical sign, X-ray film and double contrast CT. Among the patients, 14 of them were treated with the surgical procedure of anterior capsular imbrication of shoulder and the others were treated with the rehabilitation program designed by ourselves. Results: Diagnostic criteria of traumatic anterior instability of shouldet: 1. sharp, stabbing pain in the anterior aspect of the shoulder ,weakness,limitation of range of motion of the shoulder; 2. deep pain in anterior-inferior aspect of the shoulder ; 3. positive apprehension sign and anterior drawer test; 4. x-ray film of shoulder; and 5. double contrast CT. Treatment principle: 1. indication for rehabilitation program was the patients having symptoms less than 3 months and without severe anterior capsular rupture; 2. indication for the procedure of anterior capsular imbrication of shoulder was the patients having prolonged symptoms, failure to rehabilitation treatment or having severe capsular rupture. The satisfactory results were gained with averagely 21 months fol-lowing-up. Most patients were free from previous symptoms and signs except minor pain after vigorous movement of the shoulder in 3 patients and less than 20 degree limitation of the shoulder in 4 patients. Conclusion:Diagnosis of tramatic anterior instability of shoulder should be based on the information of the patient's symptom, sign, X-ray film and double contrast CT. Current rehabilitation program and anterior capsular imbrication of shoulder have proved the effective treatment for traumatic anterior instability of shoulder.