喙突截骨同轴共弧重建肩盂对肩关节复发性前脱位的疗效观察

Analysis of the effectiveness of coracoid osteotomy and concentric coaxial reconstruction of the glenoid cavity in the treatment of recurrent anterior dislocation of the shoulder joint

目的探讨喙突截骨重建肩盂治疗肩关节复发性前脱位的临床疗效。方法回顾性分析2005年1月到2020年12月陆军军医大学第一附属医院收治的103例(106肩)肩关节复发性前脱位的临床资料。其中男84例,女19例,左侧31例,右侧75例,年龄16~61(29.4±11.5)岁。术前前方恐惧试验均为阳性,均采用改良Latarjet手术通过“同轴共弧”重建肩盂缺损。随访时采用肩功能Rowe评分、简明肩关节功能测试评分(SST)以及疼痛视觉模拟(VAS)评分评估肩关节功能,记录术后肩关节复发脱位/半脱位率,X线片、CT检查评估骨性关节炎(Samilson-Prieto评分)及肩关节体侧外旋角度及肩胛下肌肌力变化。结果经过平均9.0年(1~16年)随访,转位移植的喙突骨块在术后3~6个月骨性愈合。末次随访时,Rowe评分由术前(40.4±6.5)分提高至(93.2±2.5)分(P<0.001),SST评分由术前(5.2±1.3)分提高至(10.1±1.5)分(P<0.001),VAS评分由术前(3.5±1.9)分降至(1.1±1.2)分(P<0.001)。术前肩关节体侧外旋角度为58.8°±15.6°,术后为57.6°±14.5°,差异无统计学意义(P>0.05)。肩胛下肌肌力测定健侧与患侧差异无统计学意义(P>0.05)。术后89.6%(95/106)的患者获肩盂同轴共弧重建,肩盂缺损及术后包容角较术前改善(P<0.001)。术后新发骨性关节炎7例(7/98),2例(2/8)出现关节炎进展,2例(2/98)出现切口愈合不良,2例(2/98)因骨块脱落行翻修手术。结论喙突截骨同轴共弧重建肩盂对伴明显骨缺损的肩关节复发性前脱位具有良好的临床疗效,具有低复发率、低翻修率和低骨性关节炎发生率的优势。

Objective To investigate the clinical efficacy of the modified Latarjet procedure in the treatment of recurrent anterior subluxation of the shoulder by"coaxial co-arc"reconstruction of the glenoid cavity.Methods The clinical data of 103 cases(106 shoulders)of recurrent anterior dislocation of the shoulder admitted to the First Affiliated Hospital of the Army Military Medical University from January 2005 to December 2020 were retrospectively studied.Out of these cases,84 were males and 19 were females;31 with left-sided injuries while 75 with right-sided injuries,with a mean age of(29.4±11.5)years(16-61 years).The preoperative anterior fear test was positive,and a modified Latarjet procedure was used to reconstruct the shoulder glenoid defect through a"coaxial co-arc".The Rowe score,simple shoulder test(SST)score,and Visual analogue scale(VAS)score of pain were used to assess the shoulder′s function.Parameters such as the postoperative shoulder recurrent dislocation rate,shoulder body external rotation angle,and subscapularis muscle strength changes were recorded postoperatively.Moreover,radiographs and CT scans were used to check for the incidence of osteoarthritis(Samson-Prieto score).Results After a mean follow-up of 9.0 years(1 to 16 years),bony healing occurred 3 to 6 months postoperatively.The Rowe score improved from 40.4±6.5 preoperatively to 93.2±2.5(P<0.001),the SST score improved from 5.2±1.3 preoperatively to 10.1±1.5(P<0.001),and the VAS pain score decreased from 3.5±1.9 preoperatively to 1.1±1.2(P<0.001)at the final follow-up.The angle of lateral external rotation of the shoulder joint was 58.8°±15.6°preoperatively and 57.6°±14.5°postoperatively with no statistically significant difference(P>0.05).There was no statistically significant difference in the measurement of subscapularis muscle strength between the healthy side and the affected side(P>0.05).In 89.6%of patients after surgery,coaxial co-arc reconstruction of the shoulder glenoid was obtained,and the shoulder glenoid defect and postoperative inclusion angle were significantly improved compared with those before surgery(P<0.001).Postoperatively,new-onset osteoarthritis developed in 7 cases(7/98),arthritis progressed in 2 cases(2/8),incisional healing was poor in 2 cases(2/98),and revision surgery was performed in 2 cases(2/98)due to bone mass detachment.Conclusion Coracoid osteotomy and concentric coaxial reconstruction of the glenoid cavity elicits adequate good clinical efficacy for cases of recurrent anterior shoulder dislocation,with low recurrence rates,low revision rates and low incidence of osteoarthritis.