复发性肩关节前脱位的关节镜治疗

Arthroscopic Bankart repair for the treatment of recurrent anterior shoulder dislocation

目的探讨肩关节镜下Bankart重建手术治疗复发性肩关节前脱位的适应证、手术要点和疗效。方法随访28例应用肩关节镜下Bankart重建进行治疗的复发性肩关节前脱位患者,随访10～36个月,平均16.6个月;年龄15～50岁,平均27岁。28例均为单方向性不稳定,术前平均脱位次数为15.5次(2～60次),其中22例发生于主力侧。手术中采用金属缝合锚(Mini-Revo)进行Bankart重建。随访时采用ASES评分和Constant-Murley评分进行功能评估。结果28例患者手术前及终末随访时平均ASES评分为80.5±4.1对95.1±2.1(P<0.001),其中VAS不稳定评分平均为6.8±1.2对1.1±0.7(P<0.001),肩关节平均前屈上举为161.8°±9.0°对171.4°±5.9°(P<0.001),平均外展90°外旋为59.6°±14.3°对87.1°±7.2°(P<0.001);术前及终末随访时平均Constant-Murley评分为79.3±4.0对95.0±2.2(P<0.001)。终末随访时所有病例均未发生术后再脱位,术后残存恐惧试验阳性4例(14.3%),术后外展90°外旋较健侧平均受限7.9°±5.7°(0°～20°)。所有患者均恢复术前工作,20例(71.4%)恢复到第一次脱位前的运动水平。所有患者均表示如果健侧肩关节出现相同脱位情况时仍愿意接受相同的手术治疗。结论肩关节镜下Bankart重建手术是治疗复发性肩关节前脱位的有效方法之一?

Objective To discuss the surgical techniques and results through clinical analysis of arthroscopic Bankart repair for the treatment of recurrent anterior shoulder dislocation. Methods 28 patients of recurrent anterior shoulder dislocation were treated by arthroscopic Bankart repair and followed with a mean period of 16.6 (10-36) months. The mean age was 27(15-50) years. All patients had unidirectional instabilities (TUBS), with 22 on the dominant sides. The mean number of dislocations before surgery were 15.5 (2-60). Metal suture anchoring (mini-revo, Linvatec) had been used for Bankart repair. ASES score (American Shoulder & Elbow Surgeons' score) and Constant-Murley score were adopted for final evaluation at the latest follow-up. Results The pre- and postoperative mean ASES score was 80.5±4.1 vs 95.1±2.1(P< 0.001), with the mean VAS score for instability 6.8±1.2 vs 1.1±0.7(P< 0.001), the mean forward flexion 161.8°±9.0° vs 171.4°±5.9°(P< 0.001), and the mean external rotation in 90° abduction 59.6°±14.3° vs 87.1°±7.2°(P< 0.001). The pre- and postoperative mean Constant-Murley score was 79.3±4.0 vs 95.0±2.2(P< 0.001). Redislocation wasn't found at the latest follow-up, but apprehension(mental anxious feeling) positive in 4 cases(14.3%). The mean loss of external rotation in 90° abduction was 7.9°±5.7°(0°-20°) compared with contralateral side. 20 cases(71.4%) returned to their pre-injury sports level. The reply was positive in all patients to a question: 'Do you want to accept the same operation if the same condition happens to your contralateral shoulder?' Conclusion Arthroscopic Bankart repair is a good option for the treatment of recurrent anterior shoulder dislocation. The success rate of scope surgery matches with an open reconstruction. Strict indication control, surgeon's skill and well schemed rehabilitation program are the keys to successful results.