肩关节镜治疗Bankart损伤引起复发性肩关节前脱位疗效

Shoulder arthroscopy for the treatment of recurrent shoulder anterior dislocation caused by Bankart injury

目的探讨肩关节镜治疗Bankart损伤引起的复发性肩关节前脱位的临床疗效。方法选取自2012年1月至2015年12月就诊行肩关节镜治疗的72例Bankart损伤引起的复发性肩关节前脱位患者为研究对象,患者均行术前MRI、术后MRI或DR检查。采用Constant-Murley评分、肩关节Rowe评分评估术前及术后1、6、12个月肩关节情况及稳定性;采用美国加州大学(UCLA)肩关节评分评价术后1、12个月肩关节功能。结果手术均成功完成,术后切口均甲级愈合,无感染及血管、神经损伤等手术相关并发症发生。2例患者术后6周因故脱落,1例患者术后12个月后仍有疼痛症状;其余患者随访效果满意,末次随访时未发生再脱位现象。术前及术后1、6、12个月,Constant-Murley评分总评分、Rowe评分逐渐升高,各时间点评分比较,差异均有统计学意义(P <0. 05);术后1、6、12个月,肩关节疼痛评分均较术前明显升高,差异均有统计学意义(P <0. 05);术后12个月,患者肩关节最大外展角度170°,平均外展角度(160. 9°±5. 3°);最大前屈角度175°,平均前屈角度(162. 7°±4. 9°)。术后1个月,患者平均UCLA评分(32. 6±0. 3)分;末次随访时,平均UCLA评分(34. 3±0. 4)分,与术后1个月比较,差异有统计学意义(P <0. 05)。结论肩关节镜治疗Bankart损伤引起的复发性肩关节前脱位疗效确切,且方法简单、易行,相对减少二次损伤。

Objective To investigate the effect of shoulder arthroscopy on recurrent shoulder anterior dislocation caused by Bankart injury.Methods A retrospective study was performed on 72 cases of patients who were admitted and diagnosed as with shoulder anterior dislocation induced by Bankart injury from January 2012 to December 2015.All patients received preoperative MRI,postoperative MRI or DR examination.The stability and function of shoulder joints were assessed 1,6 and 12 months after surgery by Constant-Murleyscore,Rowe score and UCLA shoulder score.Results All the operations were successfully completed,and the postoperative incisions were healed in class A,without any complications such as infection,vascular or nerve injury.Two patients were shedding for 6 weeks after surgery,and 1 patient still had pain symptoms 12 months after surgery.Other patients were followed up with satisfactory results,and no further dislocation occurred at the last follow-up.Before and 1,6 and 12 months after operation,the overall and Rowe scores of Constant-Murley and Rowe scores gradually increased,and the differences were statistically significant（ P 〈0.05）.After 1, 6 and 12 months of surgery,shoulder pain scores were significantly higher than those before surgery,and the differences were statistically significant（ P 〈0.05）.Twelve months postoperatively,patients with shoulder joint outreach angle 170 °,the average abducent angles was （160.9 °± 5.3 °）.Anteflexion angle 175 °,and the average anteflexion angle was （162.7 °± 4.9 °）.One month after surgery,the average UCLA score was （32.6±0.3）.At the last follow-up,the average UCLA score （34.3±0.4）was statistically significant compared with 1 month after surgery（ P 〈0.05）.Conclusion Shoulder arthroscopy is effective in the treatment of recurrent shoulder dislocation caused by Bankart injury,and the method is simple and easy to be performed,with relative reduction of secondary injury.