切开修补关节囊盂唇治疗肩关节前方不稳定

Open repair of Bankart lesion in the treatment of anterior instability of shoulder

目的评价切开修补关节囊盂唇复合体治疗肩关节前方不稳定的疗效。方法从2001年3月～2005年6月,34例(36肩)肩关节前方不稳定患者,27肩CT造影显示Bankart损伤,9肩有关节囊韧带肩胛颈撕脱损伤(ALPSA损伤)。按肩关节不稳定方向分型,25肩均为前方单向不稳定,11肩合并有下方不稳定。其中27例有明显的外伤史,12例合并有肱骨头后缘缺损(Hill-Sachs征)。采用带线的铆钉进行切开修补关节囊盂唇复合体的方法治疗肩关节前方不稳定,观察评价患肩的功能。结果术后随访6个月～4年,平均2．2年。肩关节功能按Walch-Duplay评分：优19肩,良12肩,中3肩,差2肩,优良率为86．1%。1例术后发生再脱位,由再次创伤造成,该患者行关节镜检查,发现修补处撕脱并盂缘缺损,再次行喙突移位固定术。结论采用切开修补关节囊盂唇复合体治疗创伤性肩关节前方不稳定,疗效肯定,肩关节功能恢复良好,并发症少,再脱位发生率低。

Objective To evaluate the outcome of open repair of Bankart lesion in the treatment of anterior instability of shoulder. Methods From March 2001 to June 2005, 34 cases （36 shoulders） of anterior instability of shoulder underwent open repair of Bankart lesion. Twenty-seven shoulders with Bankart injury were diagnosed by CT scan. Nine shoulders were diagnosed as ALPSA（anterior labrum periosteal sleeve avulsion） . Twenty-five shoulders presented with anterior instability only, and 11 combined anterior and inferior instability. Twenty-seven cases had a definite history of injury. Twelve cases presented with Hill-Sachs sign. We used open incision to repair lesions to the capsule glenoid labrum complex with suture anchors. Results The average duration of follow-up was 2.2 years （six months to four years） . By Walch-Duplay score system, the good to excellent rate was 86. 1%, the moderate rate 8.3%, and the poor rate 5.6%. Redislocation occurred in one case after operation due to injury. The rate of recurrence was 3%. Conclusion Open repair of Bankart lesion in the treatment of anterior shoulder instability can lead to good recovery of shoulder function, few complications and a low rate of recurrence.