Hill-Sachs Remplissage手术治疗骨缺损性复发性肩关节前脱位

Arthroscopic treatment for anterior shoulder instability with engaging Hill-Sachs lesions

目的 探讨关节镜下Bankart重建术辅助Hill-Sachs Remplissage手术治疗存在明显骨缺损的复发性肩关节前脱位的疗效.方法 回顾性分析随访2年以上的应用关节镜下Bankart重建术辅助Hill-Sachs Remplissage手术治疗的复发性肩关节前脱位49例患者的病例资料,男42例,女7例;接受手术时年龄16.7～54.7岁,平均28.4岁.49例均为单向不稳定,合并明显的肩盂骨性损伤及巨大的Hill-Sachs损伤.术中采用金属缝合锚钉行Bankart修补,辅助后方冈下肌腱固定填充Hill-Sachs损伤.全部病例随访24～35个月,平均29.0个月,随访时采用ASES评分、Constant-Murley评分、Rowe评分进行功能评估,观察肩关节活动度变化.结果 术前及终末随访时肩关节平均前屈上举162.9°±17.1°和170.9°±7.4°（P=0.007）,平均体侧外旋56.0°±17.6°和54.1°±17.1°（P=0.511）;ASES评分为（84.7±11.3）分和（96.0±3.4）分（P=0.000）,Constant-Murley评分为（93.3±8.7）分和（97.8±3.6）分（P=0.005）,Rowe评分为（36.8±8.5）分和（89.8±12.5）分（P=0.000）.终末随访时1例患者出现复发脱位,3例患者出现半脱位,失效率8.2%（4/49）.此4例患者恐惧试验阳性.结论 肩关节镜下Bankart重建术辅助Hill-Sachs Remplissage手术是治疗存在明显骨缺损的复发性肩关节前脱位的有效方法之一.手术适应证的正确选择、熟练的关节镜下操作技术以及术后长期、严格的功能康复锻炼是手术成功的关键.

Objective The purpose of our study was to report the results of using arthroscopic Remplissage and Bankart repair in patients who had an engaging Hill-Sachs lesion with significant glenoid bone loss. Methods We retrospectively reviewed 49 consecutive patients who underwent arthroscopic Remplissage and Bankart repair for anterior shoulder instability with a mean duration of follow-up of 29.0 months （24-35 months）. At the time of surgery the mean age of 42 men and 7 women was 28.4 years. All patients were diagnosed as recurrent anterior shoulder dislocation with a bony lesion of glenoid and an engaging HillSachs lesion. An arthroscopic Remplissage and Bankart repair using metal anchor was performed in all cases.ASES score, Constant-Murley score and Rowe score were used to evaluate the stability and the function of the shoulder. Results Patients＇ active forward elevation significantly（P=0.007） improved from 162.9°±17.1°preoperatively to 170.9°±7.4° at final follow-up. The external rotation was 56.0°±17.6° before the surgery compared with the 54.1°±17.1° postoperatively（P=0.511 ）. The ASES score, Constant-Murley score and Rowe score was 84.7±11.3, 93.3±8.7 and 36.8±8.5 preoperatively compared with 96.0±3.4, 97.8±3.6 and 89.8±12.5 postoperatively. Significant difference could be found with regard to ASES score （P=0.000）, ConstantMurley score （P=0.005） and Rowe score （P=0.000）. One redislocation happened and a subluxation was noticed in three patients （8.3%）. Conclusion Arthroscopic Remplissage combined with Bankart repair can achieve satisfactory for recurrent anterior shoulder dislocation accompany with engaging Hill-Sachs lesion.