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.

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