骨阻滞联合关节囊紧缩成形术治疗肩关节后不稳定

Treatment of posterior shoulder instability with bone block procedure and posterior capsulorrhaphy

目的采用骨阻滞联合关节囊紧缩成形术治疗肩关节后不稳定,并观察其治疗效果。方法对5例创伤性肩关节后不稳定患者采用气碘双重造影检查,明确导致肩关节后不稳定的病理因素,针对其骨和软组织结构异常,采用骨阻滞联合关节囊紧缩成形术治疗。结果气碘双重造影检查显示患肩有关节盂后缘骨性破坏、关节囊松弛和盂唇撕裂表现。采用骨阻滞联合关节囊紧缩成形术治疗后,在随访5～38个月(平均19个月)期间无一例患者诉肩关节不稳定症状。结论包括骨和软组织异常在内的多种病理因素可导致肩关节后不稳定。正确的手术治疗需纠正患者存在的病理变化,而不是对所有患者实施一种“标准”的术式。对于存在多种病理因素的肩关节后不稳定患者宜采用联合手术的方法,以纠正其各种病理变化。

Objective To investigate clinical results of the treatment of posterior shoulder instability in a combined way of bone block procedure and posterior capsulorrhaphy. Methods The double contrast CT arthrography was performed for 5 patients suffering from posterior shoulder instability so as to detect the pathology. The treatments combining bone block procedure and posterior capsulorrhaphy were carried out according to the pathological conditions of bone and soft tissue. Results The double contrast CT arthrography showed posterior bone defects, posterior glenoid labrum tear and enlargement of posterior capsular cavity, After the bone block procedure and posterior capsulorrhaphy, no patients complained shoulder instability in the follow-up of 5 to 38 months. Conclusions Many pathological factors may induce posterior shoulder instability, which should be corrected by an appropriate operation rather than a “standard” method of operation. For patients involving several pathological factors, a combined operation may be needed in order to correct various pathological changes.