关节镜与开放性两种术式治疗Bankart损伤的对比研究

A Comparative Study of Arthroscopy and Open Surgical Procedures for the Treatment of Bankart Injury

目的对比关节镜下和开放性手术两种术式治疗Bankart损伤的效果。方法选择2011年1月至2014年1月在上海市普陀区中心医院骨外科进行手术治疗的Bankart损伤患者,按照随机数字表法将患者分为关节镜组（住院期间行关节镜下手术治疗,n=20）和开放性组（住院期间行常规开放性手术,n=20）。所有患者术后接受常规治疗并按计划进行康复锻炼。观察两组患者围手术期手术时间、切口长度、术中出血量、住院时间,采用美国加州洛杉矶大学UCLA肩关节功能评分标准,对手术后6周、10周、12周患者进行评价。结果 40例患者均获随访,随访时间6~10个月,且末次随访时两组患者均未再次出现肩关节脱位。关节镜组手术时间、切口长度、术中出血量及住院时间均低于开放性组[（26±10）min比（79±8）min,（1.04±0.17）cm比（11.79±1.21）cm,（6.8±1.3）mL比（479.0±117.9）mL,（7.8±1.0）d比（13.9±0.8）d],差异有统计学意义（P〈0.05）;术后6周、10周、12周肩关节功能评分[关节镜组：（30.8±2.4）分,（32.1±2.6）分,（33.2±1.5）分;开放性手术组：（26.8±2.2）分,（27.9±1.7）分,（29.6±1.6）分]均呈上升趋势,关节镜组上升速度更快,两组在组间、不同时点间、组间·不同时点间交互作用比较差异有统计学意义（P〈0.05）。结论关节镜下手术与常规开放性手术治疗Bankart损伤,均可获得满意的临床疗效,但是关节镜下手术治疗具有创伤较小、住院时间及术后恢复时间较短等优点,关节镜手术可作为治疗Bankart损伤的有效方法。

Objective To observe the effect of arthroscopic and open operation in the treatment of Bankart injury. Methods Forty patients with Bankart injury in Shanghai Putuo District Central Hospital were selected between Jan. 2011 and Jan. 2014 and were divided to arthroscopy group（ arthroscopic operation,n =20） and open group（ conventional open operation,n = 20） according to random number table method. All patients received routine treatment and rehabilitation exercise after operation according to plan. The operation time,incision length,blood loss,hospital stay of the two groups were observed. The clinical curative effect after 6 weeks,10 weeks,12 weeks was assessed by university California UCLA shoulder score system. Results All patients were followed up for 6-10 months,and no shoulder dislocation occurred aduring the follow-up.The operation time,incision length,blood loss and hospital stay of the arthroscopy group were less than the open group[（ 26 ± 10） min vs（ 79 ± 8） min,（ 1. 04 ± 0. 17） cm vs（ 11. 79 ± 1. 21） cm,（ 6. 8 ± 1. 3） mL vs（ 479. 0 ± 117. 9） mL,（ 7. 8 ± 1. 0） d vs（ 13. 9 ± 0. 8） d],the differences were statistically significant（ P 〈 0. 05）; shoulder function score after 6 weeks,10 weeks,12 weeks of arthroscopy group were（ 30. 8 ±2. 4）,（ 32. 1 ± 2. 6）,（ 33. 2 ± 1. 5）,respectively,higher than the open group’ s（ 26. 8 ± 2. 2）,（ 27. 9 ±1. 7）,（ 29. 6 ± 1. 6）,both groups showed an up trend,and the arthroscopy group increased faster,the differences between groups,different time points,groups · time points were statistically significant（ P 〈 0. 05）.Conclusion The arthroscopic operation and open operation,can both obtain satisfactory clinical effect for Bankart injury,,but the arthroscopic operation has the advantages of less invasive,shorter hospital stay and recovery time,thus is the commonly used method for Bankart injury.