复发性肩关节前脱位的关节镜治疗

Arthroscopic Banknrt 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疗效、适应证和手术要点。方法随访40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，随访时间为24—58个月，平均35．9个月；年龄15—54岁，平均27．8岁。40例均为单方向性不稳定，术前平均脱位次数为14．1次（2—90次），其中28例发生于主力侧。术中采用金属缝合锚（Mini-Revo）进行Bankart重建。随访内容包括ASKS评分、Constant．Murley评分、VAS不稳定评分及ROWE评分进行功能评估。结果40例患者术前和终末随访时肩关节前屈上举平均为[（157．5±20．6）°，x±s，下同]和（170．0±6．7）°，体侧外旋平均为（58．5±18．9）°和（55．9±15．0）°，ASES评分平均为（82．7±16．7）和（97．2±6．9），VAS不稳定评分平均为（6．2±1．6）和（1．3±1．4），Constant-Murley评分平均为（80．5±11．1）和（98．1±3．1），Rowe评分平均为（30．4±8．7）和（92．8±15．2）。除体侧外旋术前和术后差异无统计学意义外，其余各项结果差异均有统计学意义。终末随访时有1例患者曾出现肩关节半脱位。随访时发现残存恐惧试验阳性3例（占7．5％）。所有患者均恢复术前工作，29例（占70．7％）恢复到第一次脱位前的运动水平。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。适当的病例选择、术者的关节镜下操作技术水平及术后长期而严格的功能康复锻炼是手术成功的关键。

Objective To discuss the indications, surgical techniques and results of arthroscopie Bankart repair for the treatment of recurrent anterior shoulder dislocation. Methods Fourty patients with recurrent anterior shoulder dislocation treated by arthroscopie Bankart repair were reviewed with a mean follow- up period of 35.9 （24 - 58 ） months. The mean age was 27.8 （15 - 54） years. All patients were diagnosed as unidirectional anterior instability. They were treated with arthroscopie Bankart repair. Metal suture anchors （mini-revo, Linvatec ） were used for labral reconstruction during the operation. ASES score （American Shoulder ＆ Elbow Surgeons＂ score ）, Constant- Murley score, Rowe score and VAS score of instability were used for evaluation of shoulder function. Results The preoperative ASES score , Constant-Murley score and Rowe score were（ 82.7 ± 16.7 ）, （ 80. 5 ± 11.1 ） and （ 30.4 ± 8.7 ） respectively. After the surgery they improved significantly to （ 97.2 ± 6.9 ）, （ 98. 1 ± 3. 1 ） and （ 92. 8 ± 15.2 ）. The preoperative and postoperative VAS score for instability was （ 6.2 ± 1.6 ） vs （ 1.3 ± 1.4 ）. Patients＂ active forward flexion of affected shoulder waw improved significantly from （ 157. 5 ± 20. 6 ） ° to （ 170.0 ± 6.7 ） °, while the mean external rotation was （58.5 ± 18.9）° before the surgery comparing with （55.9 ± 15.0 ）°after the surgery. One patient experienced subluxation during follow-up. Apprehension test was positive in 3 cases（7.5% ） , 29 cases（70.7% ） returned to their pre-injury sports level. All hut one patients replied ＂ Yes＂ when they were questioned as ＂Do you want to accept the same operation if the same condition happens to your eontralateral shoulder？＂ Conclusion Arthrescopie Bankart repair is a good option for the trcatmem of recurrem anterior shoulder dislocation. The success rate of scope surgery matches open reconstruction. Strict indication control, surgeong skill and comprehensive rehabilitation program are the keys to successful results.