3种手术方案治疗肩关节复发性前脱位合并肩胛骨关节盂骨缺损 > 15%及啮合性Hill-Sachs损伤的疗效比较

Comparison of the efficacy of three surgical procedures in the treatment of recurrent anterior shoulder dislocation with scapula glenoid bone defect > 15% and meshing Hill-Sachs lesion

摘要:

目的 探讨常规切开Latarjet手术、关节镜下Latarjet手术、关节镜下Bankart修复联合Remplissage手术在肩关节复发性前脱位（RASD）合并肩胛骨关节盂骨缺损 > 15%及啮合性Hill-Sachs损伤中的应用效果及安全性。方法 回顾性分析该院2022年1月－2024年12月收治的65例RASD合并肩胛骨关节盂骨缺损15%~25%及啮合性Hill-Sachs损伤患者的临床资料，根据手术方法的不同，分成A、B和C组；其中，A组实施常规切开Latarjet手术（n = 18），B组实施关节镜下Latarjet手术（n = 21），C组实施关节镜下Bankart修复联合Remplissage手术（n = 26）。比较3组患者手术情况、手术前后相关量表评分［视觉模拟评分法（VAS）、Constant-Murley肩关节评分和加州大学洛杉矶分校（UCLA）肩关节评分等］和肩关节活动度，以及术后并发症和复发情况。结果 手术时间：B组长于A组和C组（P < 0.05），A组长于C组（P < 0.05）。术中出血量和住院时间：A组多于或长于B组和C组（P < 0.05），B组多于或长于C组（P < 0.05）。3组疼痛VAS评分：术后1、6和12个月都低于同组术前（P < 0.05）。术后1和6个月疼痛VAS评分：A组均高于B组和C组同期（P < 0.05）。术后1个月疼痛VAS评分：B组高于C组（P < 0.05）。术后12个月疼痛VAS评分：3组差异不明显（P > 0.05）。比之同组术前，A组术后6和12个月，B组和C组术后1、6和12个月，UCLA肩关节评分均明显升高（P < 0.05）。术后1个月UCLA肩关节评分：A组低于B组和C组（P < 0.05），B组低于C组（P < 0.05）。术后6和12个月UCLA肩关节评分：3组患者差异均不明显（P > 0.05）。比之同组术前，A组术后6和12个月，B组和C组术后1、6和12个月Constant-Murley评分均明显升高（P < 0.05）。术后1个月Constant-Murley肩关节评分：A组低于B组和C组（P < 0.05）。术后6和12个月Constant-Murley肩关节评分：3组患者无明显差异（P > 0.05）。3组患者前屈上举活动度：术后12个月都大于同组术前（P < 0.05）。术后12个月前屈上举活动度：3组患者无明显差异（P > 0.05）。术前、术后12个月体侧外旋、外展90°外旋活动度：A组和B组组内和同期组间均无明显差异（P > 0.05）。C组体侧外旋、外展90°外旋活动度：术后12个月小于术前（P < 0.05）。术后12个月体侧外旋、外展90°外旋活动度：A组和B组均大于C组（P < 0.05）。术后并发症发生率和复发率：3组患者无明显差异（P > 0.05）。结论 常规切开Latarjet手术、关节镜下Latarjet手术、关节镜下Bankart修复联合Remplissage手术治疗RASD合并肩胛骨关节盂骨缺损15%~25%及啮合性Hill-Sachs损伤，均能有效改善肩关节功能及缓解疼痛，但两种肩关节镜手术的创伤更小，术后恢复更快。

Abstract:

Objective To investigate the efficacy and safety of conventional open Latarjet surgery, arthroscopic Latarjet surgery, arthroscopic Bankart repair combined with Remplissage surgery in the treatment of recurrent anterior shoulder dislocation (RASD) with scapula glenoid bone defect > 15% and meshing Hill-Sachs lesion.Methods The clinical data of 65 patients with RASD with 15%~25% scapula glenoid bone defect and meshing Hill-Sachs lesion admitted to our hospital from January 2022 to December 2024 were retrospectively analyzed. They were divided into group A, group B, and group C according to different surgical methods. Among them, group A underwent conventional open Latarjet surgery (n = 18), group B underwent arthroscopic Latarjet surgery (n = 21), and group C underwent arthroscopic Bankart repair combined with Remplissage surgery (n = 26). The surgical conditions, preoperative and postoperative scores of related scales [visual analogue scale (VAS), Constant-Murley shoulder score, the University of California Los Angeles (UCLA) shoulder score], shoulder range of motion, postoperative complications and recurrence were compared among the three groups.Results Operation time: group B was longer than group A and group C (P < 0.05), and group A was longer than group C (P < 0.05). Intraoperative blood loss and hospital stay: group A was more or longer than group B and group C (P < 0.05), group B was more or longer than group C (P < 0.05). The VAS scores of the three groups at 1, 6 and 12 months after operation were lower than those before operation (P < 0.05). Pain VAS score at 1 and 6 months after operation: group A was higher than group B and group C (P < 0.05). Pain VAS score at 1 month after operation: group B was higher than group C. Pain VAS score at 12 months after operation: there was no significant difference among the three groups (P > 0.05). The UCLA shoulder scores of group A at 6 and 12 months after operation and group B and group C at 1, 6 and 12 months after operation were higher than those before operation (P < 0.05). UCLA score at 1 month after operation: group A < group B < group C (P < 0.05). UCLA score at 6 and 12 months after operation: there was no significant difference among the three groups (P > 0.05). The Constant-Murley scores of group A at 6 and 12 months after operation and group B and group C at 1, 6 and 12 months after operation were higher than those before operation (P < 0.05). Constant-Murley score at 1 month after operation: group A was lower than group B and group C (P < 0.05). Constant-Murley score at 6 and 12 months after operation: three groups were equivalent (P > 0.05). Forward flexion and lifting range of motion in the three groups: at 12 months after operation > before operation (P < 0.05). Forward flexion and lifting range of motion was evaluated at 12 months after operation: there was no significant difference among the three groups (P > 0.05). The range of motion of external rotation at body side and external rotation at 90° abduction before operation and at 12 months after operation: there was no significant difference between group A and group B (P > 0.05). External rotation at body side and external rotation at 90° abduction of group C: at 12 months after operation of it was less than that before operation (P < 0.05). The range of motion of external rotation at body side and external rotation at 90° abduction was obtained at 12 months after operation: group A and group B were greater than group C (P < 0.05). Postoperative complication rate and recurrence rate: three groups were equivalent (P > 0.05).Conclusion Conventional open Latarjet surgery, arthroscopic Latarjet surgery, arthroscopic Bankart repair combined with Remplissage surgery can effectively improve shoulder joint function and relieve pain in the treatment of RASD with 15%~25% scapula glenoid bone defect and meshing Hill-Sachs lesion. However, the two shoulder arthroscopic procedures are less traumatic and have faster postoperative recovery.