肩关节镜下Bankart损伤的治疗体会

Surgical Experience of Arthroscopic Bankart Repair Using Suture Anchors

目的探讨肩关节镜下金属缝合锚钉固定治疗Bankart损伤的术后疗效及治疗体会。方法 2010年3月至2014年3月共收治38例Bankart损伤的患者,均应用全关节镜下锚定缝合技术进行Bankart修复术。其中男31例,女7例,患者手术时平均年龄29.5岁（20～39岁）,其中12例患者为初次脱位,26例患者为反复多次脱位。所有患者术前均有肩关节脱位病史。术前患者采用美国肩肘外科协会评分系统（American shoulder and elbow surgeons evaluation form,ASES）肩关节评分,平均（83.7±12.8）分,Rowe评分（36.2±7.8）分,Constant-Murley评分（85.4±8.8）分。术中所有患者均采用3～4枚金属缝合锚钉进行Bankart修复术。结果 38例患者均获随访,随访时间13～40个月,平均23个月。术后肩关节前屈上举、体侧外旋及内旋活动度较术前无明显改变,外展位外旋活动度较术前明显改变,术后ASES评分平均（96.8±4.6）分,与术前相比差异具有统计学意义;术后Rowe评分平均（90.2±11.7）分,Constant-Murley评分（97.9±7.7）分,与术前比较差异有统计学意义。术后2例患者出现再次脱位,手术失败率5.3%（2/38）。结论应用全关节镜下锚定缝合技术进行Bankart修复术是治疗Bankart损伤的有效方法。合适的手术时机,充分的松解及关节囊及韧带复合体的提拉缝合、锚钉的合理分布是手术成功的保障。

Objective To investigate the effects of arthroscopic Bankart repair using suture anchors and surgical experience. Methods From March 2010 to March 2014,a total of 38 patients of Bankart lession were treated with arthroscopicrepair using suture anchors. 31 of them were male,7 were female,the average age were 29. 5 years old（ range 20 ～ 39 years）. Among them,12 cases were primary dislocation,26 cases were recurrent dislocation,the average postoperative follow- up period were23 months（ range 13 ～ 40 months）. All patients had a history of shoulder joint dislocation. Before surgery,the average ASES scores were（83. 7 ± 12. 8）,average Rowe score（ 36. 2 ± 7. 8）,average Constant-Murley score（ 85. 4 ± 8. 8）. All patients were treated with arthroscopic Bankart repair using 3 or 4 metal suture anchors. Results Postoperative shoulder function of 38 cases,incluing flexion lift,body side external rotation and internal rotation were not obviously changed,while abduction and external rotation were significantly improved. Postoperative ASES score（96. 8 ± 4. 6）,Rowe scoring（90. 2 ± 11. 7） and constant Murley score（97. 9 ± 7. 7） were significantly improved（ P〈0. 01）. A total of 2 patients had a recurrent shoulder dislocation,failure rates were 5. 3%（2 /38）. Conclusion Arthroscopic repair using suture anchors were effective methods for the treatment of Bankart lessions. Appropriate operation time,full release,pulling suture of articular capsule and ligament complex,reasonable distribution of anchors were the key factors for the success of operations.