肩关节镜手术治疗青年初次肩关节前脱位的临床疗效分析

Clinical efficacy of endoscopic surgery and conservative treatment for Bankart injury of primary shoulder joint in young adults

摘要:

目的 探讨肩关节镜手术与传统保守方法治疗青年患者初次肩关节前脱位的临床疗效。方法 前瞻性纳入2012年－2016年在该院就诊的青年肩关节前脱位患者，共80例。其中，男49例，女31例，年龄18～40岁，平均（28.61±9.62）岁，所有患者入组前签署知情同意书，将患者随机分为A、B两组，每组各40例，A组采用肩关节镜下肩关节盂唇-韧带-关节囊复合体（ALPSALesion）修复手术治疗，B组采用患肢颈腕悬吊带贴胸壁固定保守治疗，术后经康复训练，逐渐恢复肩关节功能。所有患者均随访36个月，分别于术后18和36个月进行安大略西部肩关节不稳指数（WOSI）与DASH评分，评价两组患者的治疗效果。结果 A组有6例患者出现再次脱位，时间为术后10～15个月，B组有28例患者出现再次脱位，时间为术后6～24个月；术后随访18个月时，A组WOSI评分为（268.00±163.78）分、DASH评分为（7.08±5.03）分，均优于B组的（364.10±144.97）和（11.18±6.11）分，两组比较，差异有统计学意义（P < 0.05）；术后随访36个月显示，A组WOSI评分为（235.30±118.23）分、DASH评分为（4.12±1.96）分，与B组的（247.20±123.36）和（4.98±2.21）分比较，差异均无统计学意义（P > 0.05）。结论 对于初次肩关节前脱位的青年患者，采用肩关节镜下手术治疗后复发率低，术后肩关节功能恢复满意。

Abstract:

Objective To discuss the clinical efficacy of endoscopic surgery and conservative methods in treatment of Bankart injury of primary shoulder joint in young patients.Methods From 2012 to 2016, we screened 80 patients with shoulder joint Bankart injury who met the study requirements. There were 49 males and 31 females, and the patients were between 18 and 40 years old, with an average of (28.61±9.62) years old. All the 80 patients were divided into two groups, 40 in each. The patients received endoscopic shoulder labels-ligamental-capsular complex (ALPSA Lesion) repair surgery as group A, and the patients received conservative treatment of cervical wrist sling and chest wall fixation as group B. After rehabilitation training, the shoulder joint function was gradually restored, and the patients were followed up for 36 months after surgery. WOSI scores and DASH scores were compared between the two groups.Results In group A, there were 6 patients with recurrent dislocation within 10～15 months after surgery, and in group B, there were 28 patients with dislocation within 6 ~ 24 months after surgery. After 28 months of follow-up, WOSI score and DASH score in group A were lower than those in group B, and the difference was statistically significant (P < 0.05). Follow-up at the end of 36 months after the operation showed that there was no statistically significant difference in the score of shoulder joints between the two groups (P > 0.05).Conclusion For young patients with Bankart injury of primary shoulder joint, the recurrence rate after endoscopic surgery is low, and the postoperative recovery of shoulder joint function is satisfactory. Endoscopic surgery is feasible for young patients with Bankart injury of primary shoulder joint.