骨性Bankart损伤合并肩袖损伤的病例特点和关节镜治疗策略

Characteristics and Treatment Strategies of Bony Bankart Lesion Accompanied with Rotator Cuff Tears

目的：探讨肩关节镜下应用带线锚钉技术同期修复骨性Bankart损伤合并肩袖损伤的手术策略和术后疗效。方法：2008年6月至2015年1月共收治18例同时合并骨性Bankant损伤和肩袖损伤的患者,其中女性8例,男性10例,患者平均年龄57.9岁（40~72岁）。患者均有外伤性肩关节前脱位病史,11例急诊复位后因再脱位就医,7例因存在持续肩关节疼痛就医。18例患者均通过MRI结合X线和三维CT确诊同时存在全层肩袖损伤和骨性Bankart损伤。所有患者均于关节镜下一期修复两种损伤,手术中采用带线锚钉先固定骨性Bankart损伤,再用单排锚钉修复撕裂肩袖。结果：18例患者平均随访时间22.5个月（12~38个月）。术后3月、6月随访肩关节前屈上举和体侧外旋活动度较健侧比较差异具有统计学意义（P〈0.05）。术后1年两侧活动度差异无统计学意义（P〉0.05）。末次随访时,患侧vs健侧ASES肩关节评分为91.6±6.7分vs 93.6±4.8分,Constant-Murley评分为89.9±6.8分vs 92.0±7.9分,Rowe评分为89.3±7.1 vs 91.1±6.7,两侧比较差异无统计学意义（P〉0.05）。末次随访外展肌力双侧无显著性差异,VAS疼痛评分较术前显著改善（1.4±1.1 vs 6.2±1.9）。随访过程中1例患者曾出现半脱位,3例出现术后僵硬,经肌力和功能训练后改善,无感染、再脱位等并发症。结论：肩关节脱位同时存在骨性Bankart损伤和肩袖撕裂时,全关节镜下修复骨性Bankart损伤后再修复肩袖损伤,治疗全面,疗效肯定。

Purpose To investigate the feasibility and clinical outcomes of arthroscopic repair for combined bony Bankart lesion and rotator cuff tears using suture anchor technique. Methods From June 2008 to January 2015 ,a total of eighteen patients received simultaneous arthroscopic repair for bony Bankart lesion and rotator cuff tears in our hospital,including 10 males and 8 females with the mean age of 57.9 years （40-72 years）. History of traumatic anterior shoulder dislocation was found in all of the 18 patients,eleven of the patients underwent operation because of redislocation after emergency reduction,and the rest were treated due to the persistent shoulder pain. MRI combined with X-ray or CT confirmed that full-thickness rotator cuff tears and bony Bankart lesion existed in all patients. The bony Bankart lesion was repaired firstly with suture anchors, and then the single-row suture anchors were applied to repair the rotator cuff tears. Results The mean follow-up of the 18 patients was 22.5 months （ranging from 12 to 38 months）. Compared with the contralateral shoulder,the postsurgical shoulder manifested lesser range of motion in terms of forward flexion and external rotation 3 and 6 months after the surgery （P〈0.05）,but the deficit disappeared 1 year after the surgery （P〉0.05）. At the final follow-up,no statistical difference was found between postsurgical shoulder and contralateral shoulder with regard to the score of American Shoulder and Elbow Surgeons （91.6 ± 6.7 vs 93.6± 4.8）,Constant-Murley score（89.9 ±6.8 vs 92.0 ± 7.9）,Rowe score（89.3 ± 7.1 vs 91.1± 6.7）,or abduction strength （P〉0.05）. Visual analog scale of shoulder pain decreased significantly from 6.2 ±1.9 points preoperatively to 1.4 ± 1.1 postoperatively （P〈0.05）. During the follow-up,one patient experienced subluxation and three patients had postoperative ankylosis,and those conditions improved after active muscle strength exercise. No infection or redislocation was found during the follow-up. Conclusion Bony Bankart lesion accompanied with rotator cuff tears some time can be found in elderly patients who suffered from shoulder dislocation,and satisfactory clinical outcome of the condition can be obtained through arthroscopic repair.