关节镜下Bankart修复术治疗复发性肩关节前向不稳的疗效分析

Bankart repair under arthroscope in treatment of recurrent anterior shoulder joint instability

目的评价关节镜下Bankart损伤修复术治疗复发性肩关节前向不稳的临床疗效。方法选取2010年2月-2015年2月因肩关节脱位在该院接受手术治疗的患者共63例,其中53例获得随访,男28例,女25例;年龄16~51岁,平均27.9岁。回顾性分析其临床资料,观察并总结其疗效。采用美国加州洛杉矶大学肩关节评分系统(UCLA)、美国肩肘关节外科协会评分系统(ASES)、肩关节Constant-Murley评分、前屈上举角度、外展外旋角度以及X线征象对术后效果进行评价。各组计量数据采用独立样本t检验进行统计学分析。结果术后的ASES肩关节修正评分(97.0±6.8)分,与术前比较差异具有统计学意义(P<0.05);术后UCLA评分(29.6±2.5)分,与术前比较差异具有统计学意义(P<0.05)。术后肩关节Constant-Murley评分(99.1±2.4)分,前屈上举平均(168.7±2.7)°,外展外旋平均为(72.6±8.7)°,与术前比较差异均无统计学意义(P>0.05)。结论 Bankart修复手术前后肩关节评分具有显著差异,症状改善显著,优良率高,说明对于肩盂骨缺损较轻或无、关节囊及周围韧带组织质量较好的复发性肩关节前脱位患者,关节镜下Bankart修复术具有很好的疗效。为进一步降低复发率,术前应对Bankart修复术后复发不稳的危险因素进行充分评估。

Objective To assess the effectiveness of Bankart repair under arthroscope in treatment of recurrent anterior shoulder joint instability. Methods From February 2010 to February 2015, 63 patients with recurrent anterior shoulder dislocation under arthroscipic Bankart repair, and 53 patients （28 male, 25 female） were available for follow-up. The mean age at the time of surgery was 27.9 years （range, 16 ~？51）. All of the 63 patients underwent surgical treatments, and the effectiveness was evaluated with University of California at Los Angeles （UCLA）, American Shoulder and Elbow Surgeon scores （ASES）, Constant-Murley scores, forward elevation, abduction and external rotation and X-ray. Results The ASES scores, UCLA scores were （97.0 ± 6.8）, （29.6 ± 2.5） respectively, improved significantly higher after the surgery （P 〈 0.05）. No significant change was found regarding Constant-Murley scores （99.1 ± 2.4）, forward elevation （168.7 ± 2.7）°, abduction and external rotation （72.6 ± 8.7）° compared with the pre-operation. Conclusions Signifcant difference between pre-operation and post-operation suggests that Arthroscopic Bankart repair is a good option for the treatment of recurrent anterior shoulder dislocation without large glenoid bone loss and poor quality Ligament and joint capsule. Risk factors of recurrence should be evaluated before the surgery to reduce the recurrence rate of dislocation.