关节镜下改良自体髂骨移植解剖重建肩胛盂治疗复发性肩关节前脱位合并严重关节盂骨缺损的疗效

Efficacy of arthroscopic modified anatomic glenoid reconstruction with Enden‑Hybinette procedure in the treatment of recurrent anterior dislocation of shoulder combined with severe glenoid bone loss

目的探讨关节镜下改良自体髂骨移植结合袢钢板固定技术解剖重建肩胛盂治疗复发性肩关节前脱位合并严重关节盂骨缺损的临床疗效。方法采用回顾性病例系列研究分析2019年1月至2021年1月中国人民解放军联勤保障部队第九〇一医院收治的36例复发性肩关节前脱位合并严重关节盂骨缺损患者的临床资料,其中男28例,女8例;年龄18~33岁[(29.5±3.0)岁]。均有外伤史,脱位次数2~40次[(20.5±6.5)次]。Beighton评分3~9分[(4.0±0.8)分]。患者均接受关节镜下改良自体髂骨移植、带袢钢板弹性固定技术解剖重建肩胛盂。术前,术后1、3、6个月及末次随访时测量肩胛盂后倾角、肩胛盂宽度及前后位盂窝深度,评估重建肩胛盂骨性解剖形态。术后6个月观察髂骨骨块与关节盂骨缺损愈合情况;评估髂骨块吸收率。术前,术后3、6个月及末次随访时采用肩关节功能Rowe评分中稳定性评分、功能活动评分、关节活动度评分及Rowe评分总分评估肩关节稳定、功能活动和运动情况。观察并发症发生情况。结果患者均获随访12~24个月[(18.8±3.5)个月]。术后1、3、6个月及末次随访时肩胛盂后倾角分别为(11.3±1.7)°、(10.6±1.2)°、(9.1±2.0)°、(9.2±1.9)°,肩胛盂宽度分别为(34.2±1.3)mm、(33.2±1.0)mm、(32.2±1.0)mm、(31.3±1.1)mm,前后位盂窝深度分别为(2.6±0.1)mm、(2.4±0.1)mm、(2.3±0.2)mm、(2.2±0.2)mm,均较术前的(-5.9±1.0)°、(24.3±1.2)mm、(0.6±0.1)mm显著改善(P<0.01),术后各时间点差异均无统计学意义(P>0.05)。术后6个月髂骨骨块与关节盂骨缺损植骨后均达到骨性愈合;髂骨块吸收率为(20.5±4.1)%。术后3、6个月及末次随访时肩关节功能Rowe评分中稳定性评分分别为(41.5±6.1)分、(43.9±6.3)分、(44.7±5.0)分,功能活动评分分别为(26.9±2.5)分、(27.1±2.5)分、(28.6±2.3)分,关节活动度评分分别为(13.9±1.0)分、(14.9±1.2)分、(15.8±1.5)分,Rowe评分总分分别为(81.4±11.5)分、(85.8±12.3)分、(86.4±9.8)分,均较术前的(6.1±1.5)分、(11.9±1.5)分、(8.5±1.4)分、(27.4±7.5)分显著升高(P<0.01),术后各时间点差异均无统计学意义(P>0.05)。均未出现切口感染、神经损伤、内置物移位失效、肩关节再脱位复发及骨关节炎等并发症。结论关节镜下改良自体髂骨移植结合袢钢板固定技术解剖重建肩胛盂治疗复发性肩关节前脱位合并严重关节盂骨缺损,具有重建肩胛盂骨性解剖形态效果好、骨愈合佳、肩关节稳定性及活动功能恢复满意等优点。

Objective To investigate the clinical efficacy of arthroscopic modified anatomic glenoid reconstruction with Enden⁃Hybinette procedure combined with loop plate fixation in the treatment of recurrent anterior dislocation of shoulder combined with severe glenoid bone loss.Methods A retrospective case series study was conducted to analyze 36 patients with recurrent anterior dislocation of the shoulder combined with severe glenoid bone loss who were admitted to 901st Hospital of the Joint Logistics Support Force of PLA from January 2019 to January 2021,including 28 males and 8 females,aged 18⁃33 years[(29.5±3.0)years].All the patients had injury history.The dislocation frequency range was 2⁃40 times[(20.5±6.5)times].Beighton scale scores were 3⁃9 points[(4.0±0.8)points].All the patients underwent anatomic reconstruction of the glenoid bone with arthroscopic modified Enden⁃Hybinette procedure using iliac autograft and loop plate elastic fixation.Posterior glenoid version angle,the breadth of the glenoid cavity and the A⁃P glenoid cavity depth were measured and osseous anatomy of the reconstructed glenoid bone was evaluated.Union of the Iliac bone block and glenoid bone loss was observed and the absorption rate of the bone block was evaluated at 6 months after surgery.The shoulder stability score,functional activity score,joint range of motion score and total Rowe score of shoulder function were used to evaluate the shoulder stability,functional activity and movement before surgery,at 3,6 months after surgery and at the last follow⁃up.The incidence of complications was observed.Results All the patients were followed up for 12⁃24 months[(18.8±3.5)months].At 1,3,6 months after surgery and at the last follow⁃up,posterior glenoid version angle was(11.3±1.7)°,(10.6±1.2)°,(9.1±2.0)°and(9.2±1.9)°respectively;the breadth of the glenoid cavity was(34.2±1.3)mm,(33.2±1.0)mm,(32.2±1.0)mm and(31.3±1.1)mm respectively;the A⁃P glenoid cavity depth was(2.6±0.1)mm,(2.4±0.1)mm,(2.3±0.2)mm and(2.2±0.2)mm respectively,which were all significantly improved compared with those before surgery[(-5.9±1.0)°,(24.3±1.2)mm and(0.6±0.1)mm respectively](P<0.01),with no significant differences among those at different postoperative time points(P>0.05).Bony union was observed in the iliac bone block and glenoid bone loss after bone grafting in all the patients at 6 months after surgery and the iliac bone block resorption rate was(20.5±4.1)%.At 3,6 months after surgery and at the last follow⁃up,the shoulder stability score was(41.5±6.1)points,(43.9±6.3)points and(44.7±5.0)points respectively;the functional activity score was(26.9±2.5)points,(27.1±2.5)points and(28.6±2.3)points respectively;the joint range of motion score was(13.9±1.0)points,(14.9±1.2)points and(15.8±1.5)points respectively;the total Rowe score of shoulder function was(81.4±11.5)points,(85.8±12.3)points and(86.4±9.8)points respectively,which were significantly improved compared with those before surgery[(6.1±1.5)points,(11.9±1.5)points,(8.5±1.4)points and(27.4±7.5)points respectively](P<0.01),with no significant differences among those at different postoperative time points(P>0.05).At the follow⁃up,no complications such as incision infection,neurological injuries,implant failure of displacement,recurrent re⁃dislocation of the shoulder or osteoarthritis were observed.Conclusion Arthroscopic modified anatomic glenoid reconstruction with Enden⁃Hybinette procedure combined with loop plate fixation in the treatment of recurrent anterior dislocation of shoulder combined with severe glenoid bone loss has the advantages of better osseous anatomy of the reconstructed glenoid bone,better bony union,satisfactory shoulder stability,functional restoration,etc.