关节镜下垂直褥式缝合治疗肩关节复发性前脱位合并关节囊松弛的中期疗效

Mid‑term clinical outcome of arthroscopic vertical mattress suturing for recurrent anterior shoulder dislocation combined with joint laxity

目的探讨关节镜下垂直褥式缝合治疗肩关节复发性前脱位合并关节囊松弛的中期临床疗效。方法采用回顾性病例系列研究分析2018年1月至2021年9月陆军军医大学第一附属医院收治的11例肩关节复发性前脱位合并关节囊松弛患者的临床资料,其中男10例,女1例;年龄18~38岁[(22.8±5.5)岁]。患者均采用关节镜下垂直褥式缝合关节囊手术治疗。比较术前、术后6个月及末次随访时Oxford肩关节不稳评分、Rowe肩关节不稳评分、简便肩关节功能测试(SST)评分,以及术前及末次随访时MRI影像学肩关节囊松弛程度和冗余长度;观察末次随访时恐惧试验结果和术后关节再脱位、医源性血管或神经损伤等并发症情况;采用Spearman相关系数分析关节囊影像学改变与肩关节功能的相关性。结果患者均获随访20~64个月[(40.7±18.6)个月]。术前、术后6个月及末次随访时Oxford肩关节不稳评分分别为(41.2±4.7)分、(49.5±3.0)分和(57.6±3.0)分,Rowe肩关节不稳评分分别为(28.6±9.5)分、(77.7±7.2)分和(94.1±10.9)分,SST评分分别为(7.6±1.3)分、(9.8±1.0)分和(11.6±0.9)分。术后6个月及末次随访时Oxford肩关节不稳评分、Rowe肩关节不稳评分及SST评分显著优于术前,且末次随访时显著优于术后6个月(P均<0.05)。MRI显示,术前关节囊松弛程度和冗余长度为(1.5±0.2)、(19.7±2.5)mm,末次随访时分别为(1.3±0.2)、(12.9±3.7)mm(P<0.05或0.01)。末次随访时恐惧试验均为阴性。术后均未出现关节再脱位、医源性血管或神经损伤等并发症。相关性分析结果表明,关节囊松弛程度仅与Oxford肩关节不稳评分呈负相关(r=-0.62,P<0.05);关节囊冗余长度与Oxford肩关节不稳评分(r=-0.80,P<0.01)、Rowe肩关节不稳评分(r=-0.73,P<0.01)、SST评分(r=-0.75,P<0.01)均呈显著负相关。结论关节镜下垂直褥式缝合治疗肩关节复发性前脱位合并关节囊松弛,可显著改善肩关节功能、减少并发症,获得良好的中期疗效;肩关节功能改善与关节囊松弛程度及冗余长度减少密切相关。

Objective To investigate the mid⁃term clinical outcomes of arthroscopic vertical mattress suturing for shoulder recurrent anterior dislocation combined with joint laxity.Methods A retrospective case series study was performed on the clinical data of 11 patients with recurrent anterior shoulder dislocation combined with joint laxity admitted to the First Affiliated Hospital,Army Medical University from January 2018 to September 2021.The patients included 10 males and 1 female,aged 18⁃38 years[(22.8±5.5)years].All the patients received treatment with arthroscopic vertical mattress suturing.The Oxford shoulder instability score,Rowe shoulder instability score,and simple shoulder test(SST)score were compared before operation,at 6 months after operation and at the final follow⁃up.The degree of joint capsule laxity and length of capsular redundancy(evaluated by MRI)were compared before operation and at the final follow⁃up.The results of the supine apprehension test,re⁃dislocation and postoperative complications such as iatrogenic vascular and nerve injuries were observed at the final follow⁃up.Also,the correlation between the radiological changes in the joint capsule and the shoulder function was analyzed by Spearman correlation coefficient.Results All the patients were followed up for 20⁃64 months[(40.7±18.6)months].Before operation,at 6 months after surgery and at the final follow⁃up,the values of Oxford shoulder instability score were(41.2±4.7)points,(49.5±3.0)points and(57.6±3.0)points;the values of Rowe shoulder instability score were(28.6±9.5)points,(77.7±7.2)points and(94.1±10.9)points;and the values of SST score were(7.6±1.3)points,(9.8±1.0)points and(11.6±0.9)points,respectively.The Oxford shoulder instability score,Rowe shoulder instability score and SST at 6 months after operation and at the final follow⁃up were significantly better than those before operation,and those at the final follow⁃up were significantly better than those at 6 months after operation(all P<0.05).The MRI showed that the degree of joint capsular laxity and length of capsular redundancy were 1.5±0.2 and(19.7±2.5)mm before operation and were 1.3±0.2 and(12.9±3.7)mm at the final follow⁃up,respectively(P<0.05 or 0.01).The supine apprehension test was negative at the final follow⁃up,with no re⁃dislocation or postoperative complications such as iatrogenic vascular or nerve injuries.Correlation analysis showed a negative correlation between the degree of joint capsular laxity and the Oxford shoulder instability score(r=-0.62,P<0.05)and that of the length of capsular redundancy with the Oxford shoulder instability score(r=-0.80,P<0.01),the Rowe shoulder stability score(r=-0.73,P<0.01)and the SST score(r=-0.75,P<0.01).Conclusions Arthroscopic vertical mattress suturing has good mid⁃term clinical outcome for recurrent shoulder anterior dislocation combined with joint laxity,improving the shoulder function and reducing complications,wihch is associated with decreased joint capsule laxity and length of capsular redundancy.