关节镜下喙突转位缝线钢板固定术治疗复发性肩关节前向不稳

Arthroscopic Bristow procedure using suture-button fixation for treatment of recurrent anterior shoulder instability

目的探讨关节镜下喙突转位缝线钢板固定术治疗肩关节前向不稳的临床疗效。方法采用回顾性病例系列研究分析2015年3月至2018年9月上海市第六人民医院收治的28例复发性肩关节前方不稳患者临床资料,其中男26例,女2例;年龄18~36岁[(24.1 ± 3.2)岁]。术前MRI显示Bankart损伤且关节盂三维CT显示关节盂骨缺损 > 15%,27例合并Hill-Sachs损伤。均采用关节镜下喙突转位缝线钢板固定、带线锚钉修补关节囊盂唇复合体治疗。采用视觉模拟评分(VAS)、美国肩肘外科医师(ASES)评分、Constant评分、Rowe评分评估术前、术后3,6,12个月及末次随访时肩关节疼痛和功能情况。同时记录术后感染、神经血管损伤、再脱位等并发症发生情况。采用三维CT分析喙转位的骨吸收与骨愈合情况,并记录盂肱关节是否发生退变。结果患者均获随访22~36个月[(24.5 ± 6.3)个月]。术后3个月,VAS、ASES评分、Constant评分较术前差异无统计学意义(P > 0.05);Rowe评分较术前显著提高(P < 0.05)。术后6,12个月,VAS、ASES评分、Constant评分及Rowe评分均较术前显著改善(P < 0.05)。末次随访时VAS由术前(2.7 ± 0.5)分降至(0.8 ± 0.3)分,ASES评分由术前(78.6 ± 12.7)分增至(92.4 ± 8.4)分,Constant评分由术前(43.4 ± 5.2)分增至(81.6 ± 6.7)分,Rowe评分由术前(52.3 ± 7.1)分增至(92.7 ± 5.4)分(P < 0.05)。随访过程中未出现术后感染、神经血管损伤、再脱位等并发症。86%(24/28)喙突转位获得骨性愈合,总体骨吸收率为(18.4 ± 6.1)%。无患者出现盂肱关节骨关节炎。结论关节镜下喙突转位缝线钢板固定喙突治疗复发性肩关节前向不稳,疼痛缓解明显,功能恢复良好,并发症发生率低,喙突与肩胛盂之间具有较高的骨愈合率,是一种安全且疗效可靠的手术方案。

Objective To investigate the clinical outcome of arthroscopic suture-button Bristow procedure using suture-button fixation for treatment of recurrent anterior shoulder instability.Methods A retrospective case series study was conducted to analyze 28 patients with recurrent anterior shoulder instability admitted to Shanghai Sixth People's Hospital from March 2015 to September 2018,including 26 males and 2 females,aged 18-36 years[(24.1±3,2)years].Preoperative MRI showed Bankart injury and three-dimensional CT showed glenoid bone defect>15%.The Hill-Sachs injury was found in 27 patients.Arthroscopic Bristow procedure was used to fix coracoid process graft with the suture-button plate and glenoid labial complex was repaired with the suture anchor to treat anterior instability of the shoulder joint.The visual analogue scale(VAS),American shoulder and elbow surgeon(ASES)scale,Constant score and Rowe score were used to evaluate the shoulder joint function preoperatively,at postoperative 3,6,12 months and at the last follow-up.The postoperative infection,neurovascular injury,redislocation and other complications were recorded,and the incidence rate was calculated.The bone resorption and bone healing of coracoid process graft were analyzed by CT.Results All patients were followed up for 22-36 months[(24.5±6.3)months].Three months after operation,the VAS,ASES scale and Constant score were not significantly different from those before operation(P>0.05).In comparison,the Rowe score was significantly higher than that before operation(P<0.05).Six and twelve months after operation,the VAS,ASES scale,Constant score and Rowe score were significantly improved from those before operation(P<0.05).At the last follow-up,the VAS decreased from(2.7±1.5)points preoperatively to(0.8±0.3)points,the ASES scale increased from(78.6+12.7)points preoperatively to(92.4±8.4)points,the Constant score increased from(43.4±5.2)points preoperatively to(81.6±6.7)points,the Rowe score increased from(52.3±7.1)preoperatively to(92.7±5.4)points(P<0.05).During the follow-up,there was no infection,neurovascular injury,re-dislocation and other complications.In addition,24(86%)out of the 28 patient showed healing of coracoid process grafts,and the overall bone resorption rate was(18.4±6.1)%.No patients had glenohumeral joint osteoarthritis.Conclusion Arthroscopic Bristow procedure using suture-button fixation for treatment of recurrent anterior shoulder instability has advantages of a low rate of postoperative complications and a high union rate,indicating an effective and safe surgical procedure.