【摘要】 目的:探索一种关节镜下Latarjet手术的改良方法,并评估应用该术式治疗复发性肩关节前脱位的疗效。方法:选取2018年1月至2019年1月期间接受改良Latarjet手术治疗的11例患者,所有患者术前均诊断为复发性肩关节前脱位。术中采用改良方法预置导针,定位喙突移植物位置,并应用"旋转法"调整喙突高度,避免喙突骨量丢失。手术前、手术后第1天、术后1年行ASES评分、Rowe评分、VAS评分以及CT检查,评估疗效。结果:所有病例术后平均随访13.18个月(12～16个月),随访期间无复发脱位及半脱位,恐惧试验均为阴性。术后1年,ASES评分为98.18±2.17,Rowe评分为97.27±3.44,VAS评分为0.18±0.40,与术前ASES评分(70.61±7.35)、Rowe评分(39.09±7.35)、VAS评分(3.27±0.79)比较差异均具有统计学意义(P<0.05)。术后CT检查结果显示:所有病例均无移植物外凸;9例患者的喙突骨块与关节盂完全平齐,2例患者喙突偏内侧,均<2 mm;10例患者的喙突骨块位于2:00～5:00位置,1例过低,超过5:00;喙突骨吸收率,其中0级5例,Ⅰ级6例,未见Ⅱ、Ⅲ级病例;6例患者骨吸收均发生于β螺钉附近。结论:改良关节镜下Latarjet手术治疗复发性肩关节前脱位是一种可靠且有效的术式,具有喙突移植物位置优良及骨吸收率低的优点。更多还原

【Abstract】 Objective To evaluate the effect of the modified arthroscopic Latarjet procedure for patients with recurrent shoulder anterior dislocation.Methods Eleven patients diagnosed as recurrent shoulder anterior dislocation and undergoing modified Latarjet surgery between January 2018 and January2019 were studied retrospectively. During the operation, two guidewires were drilled into the glenoid for orientation before the coracoid transfer and the height of coracoid was adjusted in"the rotation method"to avoid the bone loss. Before as well as one day and one year after the operation,all patients were evaluated using the rating scale of the American Shoulder and Elbow Surgeons(ASES),Rowes’ rating system for Bankart repair(Rowe),visual analogue scale(VAS) and computerized tomography(CT).Results The average follow-up length was 13.18 months ranging from 12 to 16 months.There were no cases of recurrent dislocation or subluxation. One year after the operation,the average ASES,Rowe and VAS scores were 98.18 ± 2.17,97.27 ± 3.44 and 0.18 ± 0.40,showing significant differences from those before the operation(70.61 ± 7.35,39.09 ± 7.35 and 3.27 ± 0.79)(P<0.05).According to the CT scanning at the final follow-up, 9 cases had the coracoid graft completely aligned with the glenoid,2 cases had the coracoid graft medially placed(<2 mm),and none was laterally placed. Vertically,10 patients had the transplanted bone located at a good position of lower onethird of the glenoid(2 to 5 o’clock) and 1 patient was of too low position(>5 o’clock). All patients achieved bone healing,with 5 patients of grade 0 bone absorption,6 patients of grade I absorption at the upper part of bone.Conclusions For’patients with anterior shoulder dislocation and severe glenoid bone loss,the modified arthroscopic Latarjet procedure is a reliable and effective method resulting in good graft positioning and low bone absorption.更多还原