关节镜下Bankart修复联合Remplissage手术治疗军人双极损伤型肩关节复发性前脱位的疗效分析

Curative effect analysis of arthroscopic Bankart repair combined with Remplissage for the treatment of recurrent anterior dislocation of shoulder in soldiers with Bipolar lesions

摘要:

目的 评价关节镜下Bankart修复联合Remplissage手术治疗军人双极损伤型肩关节复发性前脱位的临床疗效。方法 选择2019年2月－2022年3月于该院实施手术的肩关节复发性前脱位患者15例，均为男性。年龄18～33岁，平均（23.07±4.39）岁；Beighton评分（4.40±1.89）分。左肩4例，右肩11例。术前CT评估Hill-Sachs损伤（16.93±2.17）%。记录肩关节活动度，采用美国肩肘关节外科协会（ASES）评分和Constant-Murley评分，评估肩关节功能与稳定性。结果 所有患者获得随访，随访10～28个月，平均（18.47±6.46）个月。所有患者均未出现感染、血管神经损伤及关节再脱位等并发症。肩关节前屈上举：由术前的（152.41±14.28）°增加至末次随访的（167.48±10.23）°；内旋：术前棘突水平，T₅ 1例，T₆ 2例，T₇ 6例，T₈ 3例，T₉ 2例，T₁₀ 1例，术后棘突水平，T₅ 1例，T₆ 1例，T₇ 3例，T₈ 6例，T₉ 4例；体侧外旋和外展90°外旋：分别由术前的（60.31±13.43）°和（97.41±13.17）°减小至末次随访的（51.23±14.27）°和（89.47±14.15）°；术后ASES评分和Constant-Murley评分较术前明显提高。结论 关节镜下Bankart修复联合Remplissage手术治疗军人双极损伤型肩关节复发性前脱位，临床疗效满意，肩外旋角度较术前减小，可明显降低肩关节脱位复发率，提前重返训练场。

Abstract:

Objective To evaluate the clinical effects of the treatment of recurrent anterior dislocation of shoulder in soldiers with bipolar lesions by arthroscopic Bankart repair and Remplissage surgery.Methods From February 2019 to March 2022, 15 patients with recurrent anterior dislocation of shoulder in our hospital were selected, all of whom were male;The age ranged from 18~33 (23.07±4.39) years， Beighton score was (4.40±1.89). 4 cases of left shoulder and 11 cases of right shoulder. Preoperative CT evaluation of Hill-Sachs injury was (16.93±2.17)%. The range of motion was recorded, and the function and stability of the shoulder was evaluated by the American Shoulder and Elbow Surgeons (ASES) score and Constant-Murley score.Results All patients were followed up for 10 ~ 28 (18.47 ± 6.46) months. No patient had clinical complications such as infections, neurovascular injuries and redislocation. Shoulder flexion and lifting increased from (152.41 ± 14.28)° pre-operatively to (167.48 ± 10.23)° at the latest follow-up, and internal rotation, preoperative spinous process levels were T₅ 1 cases, T₆ 2 cases, T₇ 6 cases, T₈ 3 cases, T₉ 2 cases, T₁₀ 1 cases, postoperative spinous process levels were T₅ 1 cases, T₆ 1 cases, T₇ 3 cases, T₈ 6 cases, T₉ 4 cases, the average lateral external rotation and abduction 90° external rotation decreased from (60.31 ± 13.43)°and (97.41 ± 13.17)° pre-operatively to (51.23 ± 14.27)° and (89.47 ± 14.15)° at the latest follow-up, respectively. The ASES score and Constant-Murley score were significantly improved.Conclusion The clinical effect of rehabilitation of Bankart repair combined with Remplissage under arthroscopy in the treatment of recurrent dislocation of shoulder in soldiers with Bipolar lesions is satisfactory. Although the external rotation angle of shoulder is slightly decreased after operation, it can significantly reduce the recurrence rate of shoulder dislocations and return to the training.