肩关节上盂唇前后向损伤的关节镜治疗

Arthroscopic treatment of superior labrum anterior posterior lesions

目的探讨关节镜治疗肩关节上盂唇前后向（SLAP）损伤的临床效果。方法对2000年1月至2007年12月间肩关节镜下技术治疗的29例肩关节SLAP损伤患者的治疗效果进行评估，男21例，女8例；左肩4例，右肩25例；优势肩27例，非优势肩2例。本组病例不包含合并肩峰下撞击征、肩袖撕裂、肩关节脱位为主要表现的患者。手术前、后均采用ASES评分及UCLA评分对患者肩关节功能进行评估。结果关节镜探查情况：将SLAP损伤分为九型，本组SLAPⅠ型2例，SLAPⅡ型17例，SLAPⅢ型1例，SLAPⅣ型3例，SLAPⅤ型1例，SLAPⅥ型1例，SLAPⅧ型4例。29例患者获平均26．1个月（9～89个月）随访。手术前、后肩关节评分ASES评分平均分别为（9．19±1．77）、（16．08±0．94）分，差异有统计学意义（t=19．79，P=0．000）。手术前、后肩关节UCLA评分平均分别为（19．23±3．88）、（33．23±2．08）分，差异有统计学意义（t=17．54，P=0．000）。25例达到伤前运动水平，症状完全解除；3例活动轻微受限；1例随访时疼痛症状较术前轻微缓解。13例运动员全部达到了伤前运动状态，平均力量训练时间为16．3周（3～30周），平均专项训练时间为19．1周（12～30周），平均比赛训练时间为27．3周（12～52周），正式比赛时间平均为28．1周（16～52周）。无血管、神经损伤和感染患者。结论肩关节镜技术治疗SLAP损伤安拿、有效，尤其对运动员SLAP损伤更有意义。

Objective To discuss the clinical results of arthroscopic treatment of superior labrum anterior posterior （SLAP） lesions of the shoulder. Methods A retrospective study was conducted for the 29 cases of shoulder SLAP lesions who had been treated by arthroscopy from January 2000 to December 2007. They were followed up for a mean period of 26. 1 （9 to 89） months and evaluated by UCLA （University of California at Los Angeles） and ASES （American Shoulder and Elbow Surgeons） score systems before and after operation. Cases of subacromial impingement syndrome, rotator cuff tear and shoulder dislocation were excluded from this study. Results The SLAP lesions were classified into 9 types. There were 2 cases of type Ⅰ, 17 cases of type Ⅱ, 1 case of type Ⅲ, 3 cases of type Ⅳ, 1 case of type Ⅴ, 1 case of type Ⅵ, and 4 cases of type Ⅷ. The average preoperative ASES score was 9. 19 ± 1.77 and the average preoperative UCLA score was 19.23 ±3.88. After the operation, the average ASES score was 16.08 ±0.94 and the average UCLA score was 33.23 ±2.08. The differences before and after surgery were statistically significant （ P 〈 0.05）. After surgery 25 cases achieved the same sports level as before and reported no complains. Three cases had slightly limited range of movement. In 1 case, the pain was only lightly alleviated. All the 13 athletes restored the same sports level as before. The reply was positive by all patients to the question： ＂Do you want to accept the same operation if you are injured again？＂ Conclusion Arthroscopic treatment of SLAP lesions is safe and effective.