关节镜下取自体肩胛冈肩盂植骨治疗肩关节复发性前脱位

Arthroscopic autologous scapular spine bone graft transplant for shoulder recurrent instability

目的探讨关节镜下取自体肩胛冈肩盂植骨治疗肩关节复发性前脱位的临床疗效。方法回顾性分析2016年7月至2018年8月,采用关节镜下取自体肩胛冈肩盂植骨治疗27例肩关节复发性前脱位患者资料。其中男20例,女7例;年龄30.8岁(范围,19~50岁)。27例患者肩盂均有骨缺损,缺损体积为肩盂体积的10%~15%。初次脱位到手术时间为(24.1±15.8)个月。采用关节镜下取自体肩胛冈肩盂植骨治疗。术后患侧肩关节使用外展支具固定6周,6周后开始被动活动肩关节;术后10~12周开始力量训练;6个月后开始体育活动。末次随访时采用Constant-Murley评分、上肢功能障碍评分(Disability of Arm,Shoulder and Hand,DASH)评价肩关节及上肢功能,采用视觉模拟评分(visual analogue score,VAS)评价疼痛情况。CT三维重建测量患者术后1周及末次随访时移植骨块的长、宽、高并计算骨块的吸收率。记录患者末次随访时的主观满意度。结果27例患者均获得随访,随访时间19.8个月(范围,13~39个月)。术后无一例发生感染、血管神经损伤。末次随访时患者Constant-Murley评分为(85.15±5.62)分(范围,76~94分),DASH评分为(13.39±5.51)分(范围,3.19~21.95分),VAS评分为(1.29±0.45)分(范围,1~2分);以上三个指标分别与术前相比均有明显改善。患者术后活动度为:前屈上举153°±24°,体侧外旋38°±21°,内旋70°±21°,外展139°±18°。末次随访时,骨块吸收率为46.1%±20.6%(范围,24.0%~71.7%);肩关节无一例发生持续疼痛及再脱位,恐惧试验均为阴性。患者满意度评价,19例非常满意,6例满意,2例一般。结论关节镜下取自体肩胛冈肩盂植骨治疗关节盂骨质缺损10%~15%的肩关节复发性前脱位,术后可恢复肩关节稳定性,显著提高肩关节功能,明显降低肩关节脱位复发率。

Objective To investigate the clinical outcomes and radiological results of arthroscopic autologous scapular spine bone graft transplant to treat shoulder recurrent instability.Methods Data of 27 patients diagnosed as shoulder recurrent instability with the bone defect of 10%-15%from July 2016 to August 2018 who were treated by arthroscopic autologous scapular spine bone graft transplant were retrospectively analyzed.There were 20 males and 7 females with an average age of 30.8 years old(range,19-50).The bone loss of the glenoid was 10%-15%.The time between the first dislocation and the surgery was 24.1±15.8 months.The patients were treated with arthroscopic autologous scapular spine bone graft transplant.Postoperatively the affected shoulder was immobilized by the abduction brace for 6 weeks,after that the passive motion was applied.Strengthening exercise began at 10-12 weeks and sports was allowed after 6 months.Constant-Murley score and the Disabilities of Arm,Shoulder and Hand(DASH)score were used to evaluate the shoulder function,and visual analogue score(VAS)score was used to evaluate the degree of pain.Computed tomography scans were obtained one week post-operation and at the latest follow-up,from which the length,width,height and volume of the bone graft were measured and the absorption rate of the bone graft was calculated.The subjective satisfaction degree of patients at the latest follow-up was also recorded.Results All 27 patients were followed up for 19.8 months(range,13-39 months).No infection or neurovascular injury was identified.At the latest follow-up,the Constant-Murley score was 85.15±5.62(range,76-94),the DASH score 13.39±5.51(range,3.19-21.95)and the VAS score 1.29±0.45(range,1-2),thus all of those were improved significantly compared to those of pre-operation.At the latest follow-up,the anterior flexion was 153°±24°,lateral rotation by side 38°±21°,internal rotation 70°±21°,and abduction was 139°±18°.At the latest follow-up,the absorption rate of the bone graft was 46.1%±20.6%(range,24.0%-71.7%).Among all the 27 patients,19 patients considered the outcome as very good,and 6 patients considered as good,2 patients fair.Conclusion Arthroscopic autologous scapular spine bone graft transplant could successfully treat shoulder recurrent instability with glenoid bone loss at 10%-15%.This technique could achieve satisfactory clinical results,improve glenohumeral stability,decrease the re-dislocation rate.