保留喙肩韧带喙突截骨Latarjet手术治疗复发性肩关节前脱位早期疗效

Early-term effectiveness of Latarjet procedure by coracoid osteotomy with preserving coracoacromial ligament for recurrent anterior shoulder dislocation

目的探讨双袢弹性固定Latarjet手术中采用保留喙肩韧带喙突截骨治疗复发性肩关节前脱位的早期疗效。方法2021年1月—2023年6月,采用关节镜下双袢弹性固定Latarjet手术治疗19例复发性肩关节前脱位患者,术中均采用保留喙肩韧带喙突截骨方式。男11例,女8例;年龄17~32岁,平均23.3岁。肩关节脱位3~11次,平均6.4次。病程3~35个月,平均12.9个月。患者肩关节恐惧试验均为阳性;肩关节CT示患侧肩胛盂骨缺损宽度达13%~26%,平均19.8%。比较手术前后肩关节活动度(前屈上举、体侧外旋、外展90°外旋和内旋)以及肩关节功能评分[Walch-Duplay评分、美国肩肘外科协会(ASES)评分和Rowe评分];随访影像学复查喙突骨块位置及塑形情况。结果术后切口均Ⅰ期愈合,无血管、神经损伤等并发症发生。患者均获随访,随访时间9~24个月,平均14.5个月。随访期间无肩关节再脱位发生,肩关节恐惧试验均为阴性。末次随访时,肩关节活动度(前屈上举、体侧外旋、外展90°外旋以及内旋)与术前比较,差异均无统计学意义(P>0.05);肩关节功能Walch-Duplay评分、ASES评分、Rowe评分均较术前改善,差异有统计学意义(P<0.05)。影像学复查示肩峰下间隙与术前比较无明显变化;喙突骨块与肩胛盂齐平,骨块中心均位于肩胛盂3:00~5:00位置,喙突骨块塑形与肱骨头轨迹逐渐匹配;随访期间未见盂肱关节退变。结论采用保留喙肩韧带喙突截骨的双袢弹性固定Latarjet手术可有效治疗复发性肩关节前脱位,早期疗效满意。

Objective To evaluate the early-term effectiveness of Latarjet procedure with double EndoButtons fixation for recurrent anterior shoulder dislocation by coracoid osteotomy with preserving coracoacromial ligament.Methods Between January 2021 and June 2023,19 patients with recurrent anterior shoulder dislocations were treated by arthroscopic Latarjet procedure with double EndoButtons fixation,all of which underwent coracoid osteotomy with preserving the coracoacromial ligament.There were 11 males and 8 females,with an average age of 23.3 years(range,17-32 years).Shoulder dislocations ranged from 3 to 11 times,with an average of 6.4 times.The disease duration ranged from 3 to 35 months,with an average of 12.9 months.All apprehension tests were positive.Imaging examination showed that the defect width of the ipsilateral glenoid bone was 13%-26%,with an average of 19.8%.After operation,the shoulder range of motion was examined,including flexion lift,lateral external rotation,extension 90°external rotation,and internal rotation.Shoulder joint function was evaluated by Walch-Duplay score,American Association for Shoulder and Elbow Surgery(ASES)score,and Rowe score.Imaging examinations were taken to observe the position and shaping of coracoid.Results All incisions healed by first intention and no nerve or vessel injury occurred.All patients were followed up 9-24 months(mean,14.5 months).There was no recurrence of shoulder dislocation and the apprehension tests were negative during follow-up.There was no significant difference in the shoulder range of motion(flexion lift,lateral external rotation,extension 90°external rotation,and internal rotation)between preoperation and at last follow-up(P>0.05).The Walch-Duplay score,ASES score,and Rowe score significantly improved when compared with those before operation(P<0.05).Postoperative imaging showed that coracoid graft was at the same level with the glenoid in all cases;the center of coracoid graft was located between 3 to 5 o’clock.During follow-up,there was no glenohumeral joint degeneration,the acromiaohumeral distance was not reduced when compared with preoperation,and the coracoid bone gradually formed concentric circles with the humeral head.Conclusion The Latarjet procedure with double EndoButtons fixation can effectively treat recurrent anterior shoulder dislocation by coracoid osteotomy with preserving coracoacromial ligament,and the early-term effectiveness is satisfactory.