切开Latarjet 手术治疗复发性肩关节前脱位的临床随访研究

doi:10.3969/j.issn.1671-167X.2015.02.007

摘要/Abstract

摘要：
目的：通过病例随访研究总结应用切开Latarjet手术治疗复发性肩关节前脱位的临床疗效。方法：随访22例应用切开Latarjet手术治疗的合并明显肩盂前缘骨缺损的复发性肩关节前脱位患者，平均随访时间为66.0个月。在术前拍摄肩关节X线片以及三维CT以评估术前肩关节骨性关节炎及肩盂骨缺损的严重程度。对患者进行体格检查并采用美国肩肘外科协会（American Shoulder & Elbow Surgeons’ score，ASES）、Constant-Murley和Rowe评分评估肩关节功能及稳定性。术后即刻拍摄肩关节三维CT以检查移位喙突骨块所固定位置。最终随访时，再次拍摄肩关节X线片和三维CT以评估肩关节退行性变的严重程度和喙突骨块的愈合情况，对患者进行体格检查并以前述3种评分标准评价肩关节功能及稳定性。结果：术前患肢平均主动前屈上举158.2°±28.7°，体侧外旋55.3°±15.2°，内旋达T10水平（T3~臀部）；平均肩关节ASES评分77.6±17.5，Constant-Murley评分88.3±12.5，Rowe评分40.2±12.0。最终随访时，无患者出现肩关节复发脱位，肩关节平均主动前屈上举167.7°±12.7°，体侧外旋54.3°±16.5°，内旋达T10水平（T3~L3），与术前相比差异均无统计学意义（P=0.138，P=0.765，P=0.439）；平均ASES评分93.7±9.1，Constant-Murley评分95.6±5.6，Rowe评分96.4±4.4，均较术前明显改善（P=0.001，P=0.008，P<0.001）。随访过程中3例患者肩关节退行性改变较术前加重，1例移位喙突骨块不愈合。结论：切开Latarjet手术对合并明显肩盂骨缺损的复发性肩关节前脱位患者有效，术后5年随访观察未发现肩关节骨性关节炎显著加重。

关键词: 肩脱位, 外科手术, 骨关节炎

Abstract: Objective： To investigate the results of treating patients with recurrent anterior shoulder dislocation using open Latarjet technique in a retrospective study, and to discuss the detail of the surgical technique and the results of the procedure. Methods: In the study, 22 patients with recurrent anterior shoulder dislocation treated with open Latarjet technique were followed up. The average duration of the follow-up was 66.0 months. An X-ray film and a CT scan were performed before the surgery to evaluate the degenerative change of the gleno-humeral joint and the bony defect of the glenoid. An X-ray film and a CT scan were repeated at the end of the final follow-up to find out if there was any progression of the degenerative change of the gleno-humeral joint and if the transferred coracoid process united. Physical examinations, American Shoulder & Elbow Surgeons (ASES) score, Constant-Murley score and Rowe questionnaire were used to evaluate the patients’ shoulder function before the surgery and at the end of the final follow-up. Results: Before the surgery the average forward elevation, external rotation and internal rotation were 158.2°±28.7°, 55.3°±15.2° and T10 (T3-buttock) respectively. The average ASES score, Constant-Murley score and Rowe score were 77.6±17.5, 88.3±12.5 and 40.2±12.0, respectively. At the end of the final follow-up, no redislocation happened. The average forward elevation, external rotation and internal rotation were 167.7°±12.7°, 54.3°±16.5° and T10 (T3-L3), respectively(P=0.138, P=0.765, P=0.439).No sigificant restriction was detected after the surgery regarding forward elevation,external rotation and internal rotation. The mean ASES score, Constant-Murley score, and Rowe score significantly improved to 93.7±9.1 (P=0.001), 95.6±5.6 (P=0.008) and 96.4±4.4 (P<0.001) respectively after the surgery. A progression of the degenerative change of the gleno-humeral joint was detected in 3 patients. A non-union of the transferred coarcoid was detected in 1 patient. Conclusion: Open Latarjet procedure is effective in treating the recurrent anterior shoulder dislocation patient with severe glenoid defect. No significant progression of the degenerative change of the gleno-humeral joint is detected in average 5-year follow-up.

Key words: Shoulder dislocation, Surgical procedures, operative, Osteoarthritis

中图分类号:

R684.73

朱以明, 姜春岩, 鲁谊, 李奉龙, 李旭, 李岳. 切开Latarjet 手术治疗复发性肩关节前脱位的临床随访研究[J]. 北京大学学报（医学版）, 2015, 47(2): 226-231.

ZHU Yi-Ming, JIANG Chun-Yan, LU Yi, LI Feng-Long, LI Xu, LI Yue. Clinical follow-up study after open Latarjet procedure in patients with recurrent anterior shoulder dislocation[J]. Journal of Peking University(Health Sciences), 2015, 47(2): 226-231.

参考文献

相关文章 15

[1]	苏俊琪,宋扬,谢尚. 口腔鳞状细胞癌患者修复重建术后感染的病原学特征及感染风险预测模型的构建[J]. 北京大学学报（医学版）, 2022, 54(1): 68-76.
[2]	邵振兴,宋庆法,赵宇晴,崔国庆. 一种结合线袢固定的关节镜下“嵌入式”喙突移位术:手术技术及术后影像学分析[J]. 北京大学学报（医学版）, 2021, 53(5): 896-901.
[3]	朱敬先,鲁胜楠,蒋艳芳,姜玲,王健全. 老年肩袖损伤手术患者术前肺功能的影响因素[J]. 北京大学学报（医学版）, 2021, 53(5): 902-906.
[4]	吴俊慧,陈泓伯,武轶群,吴瑶,王紫荆,吴涛,王梦莹,王斯悦,王小文,王伽婷,于欢,胡永华. 2015—2017年北京市2型糖尿病患者骨关节炎患病的相关因素[J]. 北京大学学报（医学版）, 2021, 53(3): 518-522.
[5]	林国中, 马长城, 王振宇, 谢京城, 刘彬, 陈晓东. 颈_1~2硬膜外神经鞘瘤的显微微创治疗[J]. 北京大学学报（医学版）, 2021, 53(3): 586-589.
[6]	李新飞, 彭意吉, 余霄腾, 熊盛炜, 程嗣达, 丁光璞, 杨昆霖, 唐琦, 米悦, 吴静云, 张鹏, 谢家馨, 郝瀚, 王鹤, 邱建星, 杨建, 李学松, 周利群. 肾部分切除术前CT三维可视化评估标准的初步探究[J]. 北京大学学报（医学版）, 2021, 53(3): 613-622.
[7]	杨阳,肖锋,王进,宋波,李西慧,张师杰,何志嵩,张寰,尹玲. 同期手术治疗心脏病和非心脏疾病[J]. 北京大学学报（医学版）, 2021, 53(2): 327-331.
[8]	柯岩,张蔷,马云青,李儒军,陶可,桂先革,李克鹏,张洪,林剑浩. 全髋关节置换术治疗脊柱骨骺发育不良患者Tönnis 3级髋关节骨关节炎的早期疗效[J]. 北京大学学报（医学版）, 2021, 53(1): 175-182.
[9]	孟昭婷,穆东亮. 肺叶切除术中少尿与术后急性肾损伤的关系[J]. 北京大学学报（医学版）, 2021, 53(1): 188-194.
[10]	刘世博,高辉,冯元春,李静,张彤,万利,刘燕鹰,李胜光,罗成华,张学武. 腹膜后纤维化致肾盂积水的临床分析:附17例报道[J]. 北京大学学报（医学版）, 2020, 52(6): 1069-1074.
[11]	王田,洪欣,王晓峰. 等离子针状电极在经尿道近输尿管口膀胱肿瘤切除术中的临床应用(附16例报道)[J]. 北京大学学报（医学版）, 2020, 52(4): 632-636.
[12]	熊盛炜,王杰,朱伟杰,程嗣达,张雷,李学松,周利群. 二次肾盂成形术在复发性肾盂输尿管连接部梗阻中的研究进展[J]. 北京大学学报（医学版）, 2020, 52(4): 794-798.
[13]	程嗣达,李新飞,熊盛炜,樊书菠,王杰,朱伟杰,李子奡,丁光璞,俞婷,李万强,孙永明,杨昆霖,张雷,郝瀚,李学松,周利群. 机器人辅助腹腔镜上尿路修复手术:单一术者108例经验总结[J]. 北京大学学报（医学版）, 2020, 52(4): 771-779.
[14]	林国中,王振宇,谢京城,刘彬,马长城,陈晓东. 内含终丝的骶管囊肿21例临床研究[J]. 北京大学学报（医学版）, 2020, 52(3): 582-585.
[15]	王菲,赵阳阳,关明,王晶,许向亮,刘宇,翟新利. 静脉给药镇静技术在2 582例口腔外科门诊手术中的临床应用[J]. 北京大学学报（医学版）, 2020, 52(1): 181-186.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed