关节镜下肩袖修补+关节稳定术治疗肩关节前脱位合并肩袖撕裂

关节镜下肩袖修补+关节稳定术治疗肩关节前脱位合并肩袖

撕裂

陈旭旭;李剑;王涛;康汇;窦榆生

【期刊名称】《中华创伤杂志》 【年(卷),期】2018(034)012

【摘要】Objective To investigate the efficacy of arthroscopic rotator cuff repair plus Bankart repair for anterior shoulder dislocations combined with rotator cuff rupture in patients above 40 years old.Methods A retrospective case series study was conducted to analyze the clinical data of 23 patients above 40 years old with anterior dislocation of shoulder joint and rotator cuff tear in Honghui Hospital Affiliated to Medical College of Xi'an Jiaotong University from January 2010 to September 2015.There were 10 males and 13 females,aged 40-71 years [(58.1 ± 10.3) years].All patients underwent arthroscopic rotator cuff repair plus Bankart repair.The visual analogue scale (VAS) was used to evaluate pain,the Oxford shoulder instability score (OSIS) was used to evaluate shoulder stability,and ConstantMurley shoulder score was used to evaluate shoulder function.Meanwhile,the range of motion (ROM) of shoulder joint,complications and subjective efficacy feedbacks from the patients were recorded.Results All patients were followed up for 13-46 months [(24.2 ± 10.1) months].Before operation and at the last follow-up,there was significant decrease in the VAS score [(0.6 ± 0.2) points

vs.(3.8 ± 1.2)points] and the mean OSIS score [(19.7 ± 5.5) points vs.(47.1 ± 14.1) points];significant increase was found in the Constant-Murley score [(79.1 ± 10.8) points vs.(36.6 ± 6.4) points],the ROM of ante-flexion [(149.1 ± 22.0) vs.(65.8 ± 14.7)],abduction [(119.4 ± 23.2) ° vs.(69.1 ± 16.7) °] and external rotation [(45.0 ± 11.4) ° vs.(8.9 ± 2.7) °] (all P ＜ 0.05).No significant difference was found in the ROM of internal rotation (P ＞ 0.05).There were no significant differences in the mean VAS score and OSIS score between the affected and unaffected shoulders (P ＞ 0.05),but the former had a significantly lower Constant-Murley score than the latter [(79.1 ± 10.8)points vs.(87.7 ± 9.3) points,P ＜ 0.05].In terms of the comparison of ROM,there was no significant difference in joint ante-flexion and internal rotation (P ＞ 0.05),but the affected shoulder had significantly lower ROM of external rotation and abduction [(45.0 ± 11.4) °and (119.4 ± 23.2) °] than the unaffected one [(55.9 ± 13.8) °and (153.1 ± 23.7)°] (P ＜ 0.05).The excellent-good rate of efficacy based on the subjective feedbacks from patients was 78％.Up to the last follow-up,none of the patients had wound infection or recurrent dislocation.Conclusions Arthroscopic rotator cuff repair plus Bankart repair can significantly relieve the pain,improve joint function and range of motion.Compared with the unaffected shoulder,the affected one had slight loss of function and decreased mobility in abduction and external rotation.%目的 探讨关节镜下肩袖修补+关节稳定术治疗40岁以上肩关节前

脱位合并肩袖撕裂患者的疗效.方法 采用回顾性病例系列研究分析2010年1月-2015年9月西安交通大学医学院附属红会医院收治的23例40岁以上肩关节前脱位合并肩袖撕裂患者临床资料,其中男10例,女13例;年龄40 ～71岁[(58.1±10.3)岁].均行关节镜下肩袖修补+关节稳定术治疗.采用视觉模拟评分(VAS)评价疼痛,牛津肩关节不稳评分(OSIS)评价肩关节的稳定性,Constant-Murley肩关节评分评价肩关节功能.同时记录肩关节各方向的活动度、并发症及患者主观疗效.结果 患者均获随访13 ～46个月[(24.2±10.1)个月].末次随访时,患侧肩关节VAS[(0.6±0.2)分]较术前[(3.8±1.2)分]明显降低,OSIS[(19.7±5.5)分]较术前[(47.1±14.1)分]明显下降,Constant-Murley肩关节评分[(79.1±10.8)分]较术前[(36.6±6.4)分]明显增高,关节在前屈[术前(65.8±14.7)°,术后(149.1±22.0)°]、外展[术前(69.1±16.7)°,术后(119.4±23.2)°]、体侧外旋[术前(8.9±2.7)°],术后(45.0±11.4)°]方向的活动度显著增高(P均＜0.05);体侧内旋差异则无统计学意义(P＞0.05).患侧肩关节与健侧肩关节比较,VAS和OSIS差异均无统计学意义(P＞0.05).但Constant-Murley肩关节评分患侧[(79.1±10.8)分]显著低于健侧[(87.7±9.3)分](P＜0.05).关节前屈和体侧内旋差异均无统计学意义(P＞0.05);而外旋和外展,患侧[分别为(45.0±11.4)°、(119.4±23.2)°]均显著低于健侧[分别为(55.9±13.8)°、(153.1±23.7)°](P＜0.05).患者主观疗效的优良率为78％.至末次随访,无一例出现伤口感染或再脱位.结论 对于肩关节前脱位合并肩袖撕裂,关节镜下肩袖修补+关节稳定术可以显著缓解疼痛,改善关节功能和活动度;但与健侧相比,患侧肩关节仍有轻度功能丢失以及外展、外旋活动度降低.

【总页数】7页(1075-1081)