改良Bristow—Latarjet手术治疗复发性肩前下脱位长期疗效观察

Long-term efficacy of modified Bristow-Latarjet procedure in treatment of recurrent inferoanterior shoulder dislocation

目的探讨改良Bristow—Latarjet手术治疗复发性肩关节前下脱位的长期疗效。方法采用回顾性病例系列研究分析2001年1月-2016年1月收治的90例复发性肩关节前下脱位患者临床资料，其中男72例，女18例；平均36．8岁。右肩59例，左肩31例。脱位d～32次，平均13次。肩关节不稳程度指数评分（ISIS）3～10分，平均6．4分。病程6～26个月，平均13个月。均采用改良Bristow—Latarjet手术治疗。观察术后肩关节复发脱位／半脱位率；X线片、cT检查评估骨块愈合情况；记录骨肩关节前脱位术后评分（Rowe评分）、简明肩关节功能测试（SST）评分、肩关节骨性关节炎评分（Samilson—Prieto评分）及肩关节体侧外旋角度和肩胛下肌肌力变化。结果患者均获随访1～15年，平均5．6年。随访期间均未发生再脱位或半脱位。转位的喙突骨块在术后3～6个月骨性愈合。术后Rowe评分由术前（45．6±9．4）分提高到术后（92．6±3．5）分（P〈0．01）；SST评分由术前（5．6±1．2）分提高到术后（9．6±2．8）分（P〈0．01）。Samilson—Prieto评分为轻度2例（2％）。肩关节体侧外旋角度术前为（56．7±13．9）°，术后为（54．6±14．1）°（P〉0．05）。肩胛下肌肌力：患侧背手后推为（4．9±0．9）kg，压腹试验（4．4±1．0）kg；健侧分别为（5．1±0．5）kg、（4．7±1．1）kg（P均〉0．05）。结论改良Bristow—Latarjet手术治疗复发性肩关节前下脱位具有良好的肩关节前方稳定作用，骨块愈合好，肩关节外旋不受限，肩关节骨性关节炎发生率低，肩胛下肌力不下降，中远期临床疗效满意，值得临床推广。

Objective To investigate the long-term effects of modified Bristow-Latarjet operation for treatment of recurrent inferoanterior shoulder dislocation. Methods A retrospective case series study was done on 90 patients with recurrent inferoanterior shoulder dislocation treated by modified Bristow-l,atarjet procedure from January 2001 to January 2016. There were 72 males and 18 females, with an average age of 36.8 years. There were 59 right shouders and 31 left shoulders, with dislocation for 4-32 times （ mean, 13 times）. Shoulder instability severity index score （ISIS） was 3-10 points （mean, 6.4 points ）. The duration of disease was 6-26 months （mean, 13 months）. The operation methods were coracoid lateral incision with modification, rotator cuff interval approach, double hollow compression screw fixation, and bone congruent-arc technique in standing position. Clinical evaluation was done on postoperative recurrence of shoulder joint dislocation/subluxation, bone healing evaluated by X-ray and CT, Rowe score, simple shoulder function Test （SST） score, shoulder osteoarthritis score （ Samilson-Prieto ）, body side shoulder external rotation angle and the subscapularis muscle strength. Results All patients were followed up for 1 -15 years （ mean, 5.6 years ）. The rate of redislocation or subluxation during folhow-up pwas zero. All transpositions of the coracoid got bone healing at postoperative 3-6 months. The Rowe score was increased significantly from （ 45.6 ± 9.4 ） points preoperatively to （ 92.6 ± 3.5 ） points postoperatively （ P 〈0.01 ） ; SST score was increased significantly from （ 5.6 ±1.2 ） points preoperatively to （ 9.6 ± 2. 8 ）points postoperatively at final follow-up） （P 〈 0.01 ）. Samilson-Prieto score was mild in 2 patients （2%）. The body side shoulder external rotation angles were （56.7 ± 13.9） ° preoperatively and （54.6 ± 14.1 ）° postoperatively （ P 〉 0.05 ）. With regards to subscapularis strength, the lift-off and belly-press in injured side were （4.9 ± 0.9） kg and （4.4 ± 1.0） kg, respectively （ P 〉 0.05 ）. Lift-off and belly-off in normal side were （5.1 ± 0.5 ） kg and （ 4.7 ± 1. 1 ） kg, respectively （ P 〉 0.05 ）. Conclusion The modified Bristow-Latarjet operation is a reproducible and effective technique that can restore shoulder stability, with advantages of sound bone healing, free shoulder external rotation, low incidence of shoulder joint osteoarthritis, remaining of myodynamia under scapula and hence has long-term effects and is worth of clinical applicaiton.