关节镜下无结锚钉固定治疗军事训练伤致肩关节Bankart损伤

Arthroscopic repair of Bankart lesions related to military training by using knotless anchors

目的探讨关节镜下无结锚钉固定治疗军事训练伤致肩关节Bankart损伤并前向不稳的临床疗效。方法回顾性分析陆军第八十一集团军医院骨科2019年11月—2022年3月收治的69例肩关节Bankart损伤并前方不稳患者资料,其中男性68例,女性1例;年龄18~40岁,平均27.8岁;均为军事训练伤。受伤至手术时间1~120个月,中位数(P_(25),P_(75))为12(7,18)。关节镜下无结锚钉对肩关节前方撕裂的关节囊-韧带-盂唇复合体提拉紧缩缝合,记录患者术前、术后随访时的关节活动度,采用Constant-Murley和Rowe评分系统对双侧肩关节进行临床疗效评价,定期复查肩关节MRI和X线片。结果患者均获得12~40个月门诊随访,平均24.3个月。患者均恢复日常工作,80%的患者恢复到了伤前的训练水平,10%的患者训练轻度受限,7%中度受限,3%重度受限。术后Constant-Murley评分比较显示手术侧和健侧肩关节之间差异无统计学意义[(91.4±6.1)分vs.(93.5±1.4)分,P>0.05],Rowe评分手术侧和健侧差异无统计学意义[(92.8±6.2)分vs.(95.6±2.0)分,P>0.05];与健肩(手臂贴着身体,肘关节屈曲90°)相比,手术侧外旋平均丢失3°(0°~8°)。随访X线片和MRI未见无结锚钉出现松动、脱出,未发现盂肱关节退行性关节炎的征象。结论关节镜下采用无结锚钉固定治疗军事训练伤致肩关节Bankart损伤并前向不稳效果确切、可靠。

Objective To investigate the clinical efficacy of arthroscopic repair of military training-related Bankart lesions combined with anterior instability by using knotless anchors.Methods A retrospective analysis was conducted on the medical records of 69 patients with Bankart lesions and anterior instability of the shoulder joint admitted to the Orthopedics Department,Hospital of the PLA 81st Group Army,from Nov.2019 to Mar.2022.Among them,there were 68 males and 1 female aged 18-40 years,mean 27.8 years.All the injuries were related to military training.The interval between injury and surgery ranged 1-120 months,median(P_(25),P_(75))was 12(7,18).Arthroscopic surgery was performed using knotless anchors to repair the tear of the anterior capsuloligamentous complex.Pre-and post-operative joint range of motion was recorded,and the clinical outcomes were evaluated using the Constant-Murley and Rowe scoring systems.Regular shoulder MRI and X-ray exams were conducted after surgery.Results Patients were followed up for 12-40(mean 24.3)months.All of them returned to normal work and 80%recovered to their pre-injury level of activities,10%experienced mild functional limitation,7%moderate limitation and 3%severe limitation.Comparison between the surgery shoulder and the healthy contralateral side revealed no significant difference either in Constant-Murley score(91.4±6.1 vs.93.5±1.4)or in Rowe score(92.8±6.2 vs.95.6±2.0,both P>0.05).Further comparison with the contralateral healthy shoulder(arm against the body with the elbow flexed at 90°)showed an average external rotation loss of 3°(0°-8°).Follow-up X-ray and MRI images revealed no signs of loosening or dislodgement of the knotless anchors,nor any signs of glenohumeral osteoarthritis.Conclusion The arthroscopic repair using knotless anchors to manage Bankart lesions and anterior shoulder instability following military training can achieve definite effects and is a reliable choice in clinic practice.