全关节镜下弹性固定Latarjet手术治疗合并严重骨缺损的肩关节前向不稳临床研究

Suture button fixation Latarjet procedure under total arthroscopy for treatment of anterior shoulder instability with severe bone defect

目的评估全关节镜下弹性固定Latarjet手术治疗合并严重骨缺损的肩关节前向不稳的疗效。方法回顾分析2020年6月—2023年2月采用全关节镜下弹性固定Latarjet手术治疗的15例符合选择标准的合并严重骨缺损的肩关节前向不稳患者临床资料。其中男11例,女4例;年龄20~54岁,平均31.1岁。三维CT示关节盂骨缺损16.3%~35.2%,平均24.4%。肩关节脱位3~8次,平均4.2次。病程6~21个月,平均10.6个月。记录手术时间、术中出血量;手术前后采用疼痛视觉模拟评分(VAS)评估疼痛缓解情况,Rowe评分、WalchDuplay评分、美国肩肘外科协会(ASES)评分评价肩关节功能恢复情况;评估肩关节各向活动度(range of motion,ROM),包括主动前屈、体侧外旋、外展90°外旋和内旋。术后6个月和末次随访时行三维CT检查,观察移植骨块吸收情况、骨块与关节盂位置以及骨块愈合情况。结果所有患者手术均顺利完成,手术时间85~195 min,平均123.0 min;术中出血量20~75 mL,平均26.5 mL。15例患者均获随访,随访时间13~32个月,平均18.7个月。随访期间患者均未出现肩关节感染、关节僵硬、血管神经损伤等严重并发症。1例术后3个月出现移植骨部分吸收、骨不连,但末次随访时肩关节疼痛较术前改善,未发生肩关节再脱位等情况;其余患者未发生明显骨块骨折、肩关节脱位等情况。术后6个月随访时骨块均已愈合。末次随访时,患者VAS评分、Rowe评分、Walch-Duplay评分和ASES评分均较术前改善,差异有统计学意义(P<0.05);肩关节主动前屈、体侧外旋、外展90°外旋和内旋ROM与术前比较,差异均无统计学意义(P>0.05)。结论全关节镜下弹性固定Latarjet手术治疗合并严重骨缺损的肩关节前向不稳,术后临床功能改善明显,影像学检查提示移植骨块位置满意。

Objective To assess the effectiveness of suture button fixation Latarjet procedure under total arthroscopy for anterior shoulder instability with severe bone defects.Methods The clinical data of 15 patients with severe bone defects and anterior shoulder instability treated with suture button fixation Latarjet procedure under total arthroscopy between June 2020 and February 2023 was retrospectively analyzed,including 11 males and 4 females,with an average age of 31.1 years(range,20-54 years).Three-dimensional CT showed that the average glenoid bone defect was 24.4%(range,16.3%-35.2%).The average number of shoulder dislocation was 4.2 times(range,3-8 times).The disease duration ranged from 6 to 21 months with an average of 10.6 months.The operation time and intraoperative blood loss were recorded.The pain relief was evaluated by visual analogue scale(VAS)score,and the functional recovery of shoulder joint was evaluated by Rowe score,Walch-Duplay score,and American Association for Shoulder and Elbow Surgery(ASES)score before and after operation.The range of motion(ROM)of the shoulder joint was assessed,including active flexion,lateral external rotation,abduction 90°external rotation,and internal rotation.Three-dimensional CT was performed at 6 months after operation and at last follow-up to observe the absorption of bone graft,the position of bone graft and glenoid,and the healing of bone graft.Results The operation was successfully completed in all patients.The operation time was 85-195 minutes,with an average of 123.0 minutes.The intraoperative blood loss was 20-75 mL,with an average of 26.5 mL.All patients were followed up 13-32 months,with an average of 18.7 months.During the follow-up,there was no serious complication such as shoulder joint infection,joint stiffness,or vascular and nerve injury.One patient had partial absorption of the transplanted bone and bone nonunion at 3 months after operation,but the pain of the shoulder joint relieved at last follow-up,and no redislocation of the shoulder joint occurred;no obvious bone fracture or dislocation of the shoulder joint was found in the other patients.Bone union was achieved at 6 months during follow-up.At last follow-up,the VAS score,Rowe score,Walch-Duplay score,and ASES score significantly improved when compared with those before operation(P<0.05),while the ROM of active flexion,lateral external rotation,abduction 90°external rotation,and internal rotation of the shoulder joint was not significantly different from those before operation(P>0.05).Conclusion Suture button fixation Latarjet procedure under total arthroscopy can improve shoulder joint function in patients with severe anterior shoulder instability caused by bone defects,and imaging also indicates satisfactory placement of transplanted bone blocks.