关节镜下改良线袢法Latarjet术在明显关节盂骨缺损伴肩关节复发性前脱位中的应用

Application of arthroscopic modified Latarjet procedure with suture anchor for significant glenoid bone defect in recurrent anterior shoulder dislocation

目的探讨关节镜下改良线袢法Latarjet术在明显关节盂骨缺损伴肩关节复发性前脱位中的应用价值。方法回顾性分析2019年5月—2020年6月我院收治的65例明显关节盂骨缺损伴肩关节复发性前脱位患者的一般资料,患者均开展关节镜下改良线袢法Latarjet术。对患者进行为期3年的随访,比较患者术前和术后3年关节主动活动度,疼痛情况(VAS评分)、肩关节功能(ASES、ROWE、Constant-Murley评分)及术后即刻、半年、1年、2年、3年的移位骨块整体体积吸收情况。结果与术前相比较,术后3年患者前屈上举、内收活动度均有所提升(P<0.05);体侧外旋、外展90°外旋活动度则较术前下降,但差异无统计学意义(P>0.05)。与术前相比较,术后3年患者VAS评分降低,ASES、ROWE、Constant-Murley评分提升(P<0.05)。术后1 d经肩关节CT和三维重建扫描结果显示,65例患者移位喙突位置良好,肩关节盂达正常水平,且无骨性关节炎情况发生。与术后即刻相比较,患者术后半年、1年、2年、3年骨块的平均体积较小(P<0.05);但术后2年和术后1年、术后3年和术后2年相骨块的平均体积比较,差异无统计学意义(P>0.05)。结论将关节镜下改良线袢法Latarjet术应用于明显关节盂骨缺损伴肩关节复发性前脱位患者的治疗中,有利于改善患者关节主动活动度,减轻术后疼痛,且在促进患者肩关节功能恢复方面具有积极意义。

Objective To explore the application value of arthroscopic modified Latarjet procedure with suture anchor in the treatment of recurrent anterior shoulder dislocation with significant glenoid bone defect.Methods A retrospective analysis was conducted on the general data of 65 patients with recurrent anterior shoulder dislocation and significant glenoid bone defect admitted to our hospital from May 2019 to June 2020.All patients underwent arthroscopic modified Latarjet procedure with suture anchor.The patients were followed up for 3 years,and the range of motion of the shoulder joint,pain level(VAS score),shoulder joint function(ASES,ROWE,Constant-Murley scores),and the absorption of the displaced bone block were compared between preoperative and 3 years postoperative.Results Compared with preoperative measurements,the range of motion in forward flexion and abduction of the shoulder joint significantly improved at 3 years postoperative(P<0.05).The range of motion in lateral rotation and external rotation at 90°abduction decreased slightly but without statistical significance(P>0.05).The VAS score decreased,and the ASES,ROWE,and Constant-Murley scores improved significantly at 3 years postoperative compared with preoperative measurements(P<0.05).Postoperative CT and three-dimensional reconstruction scans on the first day showed that the position of the displaced coracoid process was satisfactory in all 65 patients,the glenoid reached a normal level,and no cases of osteoarthritis occurred.The average volume of the bone block was smaller at 6 months,1 year,2 years,and 3 years postoperative compared with immediately postoperative(P<0.05).However,no significant difference was observed in the average volume of the bone block between 2 years and 1 year postoperative,and between 3 years and 2 years postoperative(P>0.05).Conclusion The application of arthroscopic modified Latarjet procedure with suture anchor in the treatment of recurrent anterior shoulder dislocation with significant glenoid bone defect can promote the range of motion of the shoulder joint,reduce postoperative pain,and have a positive effect on promoting shoulder joint function recovery.