改良弹性固定Latarjet术治疗伴明显关节盂骨缺损复发性肩关节前脱位的短期随访

Short-term follow-up of modified elastic fixation Latarjet procedure for recurrent anterior dislocation of shoulder with obvious glenoid bone defect

背景:关节镜辅助下Latarjet术虽然是治疗伴有明显关节盂骨缺损所致前向不稳定的“金标准”,但存在较高的肩关节退变进展等并发症,采用关节镜下改良弹性固定Latarjet术近年来的临床效果较好,但多为个案报道,有必要深入评估改良弹性固定Latarjet术治疗伴盂骨缺损的复发性肩关节前脱位的疗效。目的:观察关节镜下改良弹性固定Latarjet术治疗伴盂骨缺损的复发性肩关节前脱位的早期疗效。方法:选择遵义医科大学附属医院2017年1月至2019年10月收治的伴明显关节盂骨缺损的复发性肩关节前脱位患者42例,均采用关节镜下改良弹性固定Latarjet术治疗。比较术前、术后目测类比评分、美国加州大学肩关节系统评分、美国肩肘外科协会评分、Rowe评分及Walch-Duplay评分,术后复查肩关节CT+三维重建及肩关节平片,评估骨块位置、肩盂缺损纠正程度、肩关节退变情况以及转位喙突愈合吸收等。结果与结论:①42例患者手术过程顺利,术后无神经、血管损伤等严重并发症,所有患者均接受随访,随访时间20-34个月;②患者术后10 d目测类比评分及末次随访美国加州大学肩关节系统评分、美国肩肘外科协会评分、Rowe评分、Walch-Duplay评分均较术前明显改善,所有患者均未再次出现脱位及半脱位;③末次随访所有患者行肩关节CT示肩关节盂达正常水平,无转位喙突吸收及骨不连;④提示关节镜下改良弹性固定Latarjet术治疗伴明显盂骨缺损的复发性肩关节前脱位可获得满意疗效,手术时间短,兼有关节镜下手术微创、精细等优点,喙突位置满意,术后无复发脱位及半脱位,可以显著改善肩关节功能。

BACKGROUND:Although arthroscopically assisted Latarjet procedure is the“gold standard”for the treatment of recurrent anterior dislocation of shoulder with obvious glenoid bone defect,it has high complications such as shoulder joint degeneration and progression.The clinical effect of the arthroscopically modified elastic fixation Latarjet procedure has been good in recent years,but most of them are case reports.Modified elastic fixation Latarjet procedure in the treatment of recurrent anterior dislocation of shoulder with obvious glenoid bone defect is necessary to be further evaluated.OBJECTIVE:To investigate the short-term clinical effect of modified elastic fixation Latarjet procedure in the treatment of recurrent anterior dislocation of shoulder with glenoid bone defect.METHODS:Totally 42 patients with recurrent anterior dislocation of shoulder with obvious glenoid bone defect diagnosed and treated in Affiliated Hospital of Zunyi Medical University from January 2017 to October 2019 were collected into our study.They were treated with modified elastic fixation Latarjet procedure.Visual analogue scale score,university of California at Los Angeles shoulder rating scale,American shoulder and elbow surgeons,Rowe score and Walsh-Duplay score were compared before and after surgery.Postoperative CT and 3D reconstruction of shoulder joint and plain radiograph of shoulder joint were performed to evaluate the position of bone fragments,the degree of correction of glenoid defect,the degeneration of shoulder joint,and the healing and absorption of transposition coracoid process.RESULTS AND CONCLUSION:(1)The operation process of 42 patients was successful,and there were no serious complications such as nerve or vascular injury after operation.All patients completed the follow-up of 20-34 months.(2)The visual analogue scale score,university of California at Los Angeles shoulder rating scale score,American shoulder and elbow surgeons score,Rowe score,Walsh-Duplay score were significantly improved at 10 days after surgery compared with before operation,and no dislocation or subluxation occurred again in all patients.(3)At the last follow-up,all patients underwent shoulder CT,which showed that the shoulder glenoid reached the normal level,without transposition,coracoid process absorption or bone nonunion.(4)The modified elastic fixation Latarjet procedure can obtain satisfactory clinical effect in the treatment of recurrent anterior dislocation of shoulder with obvious glenoid bone defect.The operation time is short,with minimally invasive and fine arthroscopic operation.The position of coracoid process is satisfactory.There is no recurrent dislocation or subluxation after operation.It can significantly improve the function of shoulder joint.