关节镜下双袢法Latarjet手术治疗伴关节盂骨缺损的肩关节复发性前脱位后肩峰下间隙宽度变化的影像学观察

Imaging observation of the acromiaohumeral distance after arthroscopic double-button Latarjet procedure for recurrent anterior shoulder dislocation complicated with glenoid bone defect

目的通过影像学观察患者在接受改良双袢法Latarjet手术后肩峰下间隙改变的情况。方法回顾性分析2014年10月至2016年10月在深圳大学第一附属医院运动医学科实施的关节镜下双袢法Latarjet手术治疗的52例伴有明显关节盂骨缺损的肩关节复发性前脱位患者资料。男33例,女19例;左肩30例,右肩22例;年龄19~45岁,平均29.6岁。关节盂骨性缺损为17%~30%(平均23.4%)。术前双侧及患侧术后即刻、术后6个月、18个月、36个月行肩关节CT检查,观察骨块愈合及塑形情况,测量并对比患侧不同时间段肩峰下间隙(AHD)宽度与健侧的差异。记录并比较术前与末次随访时美国肩肘关节外科医师协会评分(ASES)、Rowe评分及Walch-Duplay评分。结果术后52例患者获37~44个月(平均40.6个月)随访。与术前健侧AHD值(7.8±0.8)mm相比,患侧术后即刻(9.6±0.7)mm、术后6个月(8.6±0.9)mm、术后18个月(8.0±0.8)mm、术后36个月(7.9±0.8)mm均增宽,差异均有统计学意义(P<0.05)。与术前ASES评分(67.3±9.1)分、Rowe评分(40.1±4.2)分及Walch-Duplay评分(63.5±9.0)分相比,末次随访时各项评分[(93.9±3.2)、(94.5±2.7)、(95.7±3.6)分]患者均有明显改善,差异均有统计学意义(P<0.05)。末次随访时,无患者出现慢性肩关节疼痛、肩袖损伤、肩峰撞击相关症状及体征。结论关节镜下双袢法Latarjet手术治疗伴关节盂骨缺损的肩关节复发性前脱位后,术侧AHD随着时间逐渐恢复至近似健侧大小,其现象可能有助于消除Latarjet术后发生肱骨头上移不稳、甚至后续肩袖损伤的顾虑。

Objective To observe the changes in acromiaohumeral distance(AHD)in patients undergoing the modified arthroscopic double-button Latarjet procedure for recurrent anterior shoulder dislocation complicated with glenoid bone defect.Methods A retrospective study was performed of the 52 patients who had undergone the modified arthroscopic double-button Latarjet procedure from October 2014 to October 2016 at Department of Sports Medicine,The First Affiliated Hospital to Shenzhen University for recurrent anterior shoulder dislocation complicated with glenoid bone defect.They were 33 males and 19 females,having 30 left and 22 right shoulders affected.Their ages ranged from 19 to 45 years(mean,29.6 years).Their glenoid bone defects ranged from 17%to 30%(mean,23.4%).CT scans were performed on the surgery side to observe the healing and reshaping of the bone grafts and to measure the AHDs of healthy shoulder,immediately,6,18 and 36 months after operation.Their American Shoulder and Elbow Surgeons(ASES),Rowe and Walch-Duplay scores were recorded before operation and at the final follow-up for comparison.Results The follow-up time for this series ranged from 37 to 44 months(mean,40.6 months).The AHDs at immediate postoperation(9.6 mm±0.7 mm),6 months postoperation(8.6 mm±0.9 mm),18 months postoperation(8.0 cm±0.8 cm)and 36 months postoperation(7.9 cm±0.8 cm)were significantly wider than the healthy side value(7.8 mm±0.8 mm)(P<0.05).The ASES,Rowe and Walch-Duplay scores at the final follow-up(93.9±3.2,94.5±2.7 and 95.7±3.6)were significantly improved than the preoperative values(67.3±9.1,40.1±4.2 and 63.5±9.0)(P<0.05).The final follow-ups observed no symptoms or signs of chronic shoulder pain,rotator cuff injury or acromion impingement.Conclusion As the AHD becomes wider rather than narrower after arthroscopic double-button Latarjet procedure for recurrent anterior shoulder dislocation complicated with glenoid bone defect,no subsequent rotator cuff injury may happen due to the uplift of the humeral head after the modified arthroscopic double-button Latarjet procedure.