关节镜下自体髂骨移植治疗男性青年人群复发性肩关节前脱位的效果研究

Effect of arthroscopic autologous iliac bone grafting in the treatment of recurrent anterior shoulder dislocation in young men

目的研究关节镜下自体髂骨移植治疗青年人群复发性肩关节前脱位合并严重骨缺损的临床疗效。方法选取2018年8月至2020年3月武警广东省总队医院收治的复发性肩关节前脱位合并严重骨缺损患者23例作为研究对象,患者行全内镜下自体髂骨移植重建关节盂的手术治疗。患者术后通过三维计算机断层扫描(CT)和重建评估移植骨块的位置。肩关节功能采用美国肩肘外科协会(ASES)评分、Constant-Murley评分、Rowe评分和关节主动活动度进行评估。结果患者均为年轻男性,年龄19~34岁;受伤处右肩10例,左肩13例;术前脱位次数为5~50次;致伤原因为投掷训练7例,格斗训练6例,器械训练4例,战术训练4例,其他2例。所有患者术后均获得随访,随访时间为10~22个月。所有患者均未发生再脱位,无感染、血肿、取骨处不适等并发症。患者术前平均前屈上举(153.87±15.15)°,末次随访时平均前屈上举(167.74±6.70)°,差异有统计学意义(P<0.05),而平均内旋、体侧外旋和外展90°外旋比较差异无统计学意义(P>0.05)。术前及末次随访时平均ASES评分为(70.63±12.99)、(91.44±4.67)分,Constant-Murley评分为(80.57±11.31)、(93.30±3.97)分,Rowe评分为(36.09±8.11)、(91.52±3.82)分,末次随访时功能评分明显改善,差异均有统计学意义(P<0.05)。末次随访时,三维CT评估植骨块位置垂直方向良好20例,过高2例,过低1例;内外方向良好21例,偏内1例,偏外1例。所有患者均为骨性愈合,骨块均有不同程度的吸收塑形,均可恢复日常生活和工作,无脱位和不稳感。结论关节镜下自体髂骨移植重建肩盂骨缺损是治疗合并严重骨缺损的复发性肩关节前脱位的有效方法。

Objective To investigate the clinical effect of arthroscopic autogenous iliac bone grafting in the treatment of recurrent anterior dislocation of shoulder joint with severe bone defect in young men.Methods A total of 23 patients with recurrent anterior dislocation of shoulder combined with severe bone defect admitted to this hospital from August 2018 to March 2020 were selected as the study objects.The patients underwent endoscopic reconstruction of glenoid bone with autogenous iliac bone graft.The location of the graft was evaluated by three-dimensional computed tomography(CT)and reconstruction.Shoulder joint function was evaluated using the American Shoulder Elbow Surgeons(ASES)score,Constant-Murley score,Rowe score and active range of motion.Results All patients were young males,aged 19-34 years.Injuries occurred in 10 cases on the right shoulder and 13 on the left shoulder.The number of dislocations before operation was 5-50.The causes of injury were throwing training in 7 cases,fighting training in 6 cases,equipment training in 4 cases,tactical training in 4 cases and other 2 cases.All patients were followed up for 10 to 22 months.No redislocation occurred in all patients,and no complications such as infection,hemato ma,and discomfort at bone extraction site were found.The mean anterior flexion upward lift was(153.87±15.15)before surgery,and the mean anterior flexion upward lift was(167.74±6.70)at the last follow-up,with statistical significance(P<0.05),while the mean internal rotation,lateral external rotation and 90 degree external rotation with abduction had no statistical significance(P>0.05).The average ASES scores before surgery and at the last follow-up were(70.63±12.99)and(91.44±4.67),and Constant-Murley scores were(80.57±11.31)and(93.30±3.97).Rowe scores were(36.09±8.11)and(91.52±3.82),and functional scores were significantly improved at the last follow-up,with statistical significance(P<0.05).At the last follow-up,20 cases were evaluated by 3D CT with good vertical position,2 cases were too high and 1 case was too low.There were 21 cases with good internal and external orientation,1 case with insides and 1 case with outsides.All patients had bone healing,bone mass had different degrees of absorption and shaping,and all could return to daily life and work without dislocation and instability.Conclusion Arthroscopic autogenous iliac bone grafting for reconstruction of scapular bone defect is an effective method for the treatment of recurrent anterior dislocation of shoulder joint complicated with severe bone defect.