【作者】 张杰；

【导师】 于腾波；

【作者基本信息】 青岛大学 ， 骨科学（专业学位）， 2025， 硕士

【摘要】 目的:Bristow-Latarjet手术是治疗复发性肩关节前脱位伴关节盂明显骨缺损的首选手术,但其较高的并发症发生率仍是临床面临的挑战之一。为了降低并发症,提高手术的满意度,本研究提出了一种改良手术方式,即在进行关节盂暴露和喙突移植物固定的时候,保持肩关节处于0°外展与90°外旋位,并使用带线锚钉修复关节囊与盂肱韧带。通过与传统手术的对比,评估该改良术式在改善肩关节功能、降低神经损伤的风险以及促进患者重返运动等方面的临床表现,旨在为复发性肩关节前脱位的患者提供一种更有效、安全的手术方法。方法:本研究选取了2022年1月至2024年2月期间,因肩关节复发性前脱位接受手术治疗的患者,将患者随机分为改良手术组(Modified Latarjet,ML)与传统手术组(Traditional Latarjet,TL)并接受相应的手术治疗。记录患者的一般资料、术前肩关节活动度、视觉模拟评分(Visual Analogue Scale,VAS)、Rowe评分、美国肩肘协会评分(American Shoulder and Elbow Surgeons’Form,ASES)以及加州大学肩关节评分(University of California at Los Angeles Shoulder Scale,UCLA)。通过影像学检查,评估患者关节盂骨缺损的大小及合并Hill-Sachs损伤的情况,术中记录两组患者的手术时间及出血量,术后所有患者遵循统一的程序化康复流程。在术后第1个月、第3个月、第6个月以及1年时进行随访,记录两组患者的肩关节活动度、VAS、Rowe、ASES以及UCLA评分,并要求患者对手术效果进行满意度评分。我们还记录了患者术后1年时返回运动的情况、对自己运动表现的满意度以及肩关节外伤后不稳定—恢复运动评分(Shoulder Instability?Return to Sport after Injury,SIRSI)。术后第1天,术后第6个月以及术后1年时对患者进行CT检查,评估移植物骨块的位置、骨溶解情况、骨愈合情况以及肩关节炎程度。随访期间,详细记录并发症的发生情况,如有神经损伤,则进行肌电图检查,明确受累神经。组内比较采用配对t检验,组间比较采用卡方检验或独立样本t检验,所有结果以P<0.05认为有统计学意义。结果:最终共有38名患者纳入本研究,其中ML组20名患者,TL组18名患者。两组患者的一般资料、术前功能评分以及活动度均无显著差异。术后第1个月时,两组患者的功能评分及活动度均出现下降,自术后第3个月起逐步改善。与TL组患者相比,ML组患者术后第3个月和术后第6个月时,拥有更高的Rowe评分(62.00±8.34 vs.53.61±11.48;83.75±10.37 vs.75.83±11.66)、UCLA评分(21.75±2.17 vs.18.56±2.64;26.80±2.38 vs.24.39±2.25)及ASES评分(67.33±7.90 vs.61.39±6.94;77.25±4.96 vs.73.06±6.52)(P<0.05)。术后1年随访时,两组各项功能评分及活动度无显著差异,但两组患者功能评分均较术前获得显著提升(P<0.05);活动度方面,除一定程度的外旋受限外(P<0.05),其他各向活动度较术前均无显著变化。ML组中患者对手术效果的满意度评分为8.20±0.70,显著高于TL组(P<0.05)。术后1年时返回运动的情况、运动表现的满意度及SIRSI评分方面,两组患者无显著差异。术后影像学结果显示两组患者移植物位置、骨溶解程度、骨愈合情况及肩关节炎分级无显著差异。TL组报告了2例神经损伤,肌电图结果显示1例累及腋神经,1例累及肩胛上神经,经过3个月的系统治疗,两名患者临床症状均消失,两组患者在其他并发症发生率上无显著差异。结论:该改良Bristow-Latarjet手术显著改善了患者的功能预后,且未增加手术时间或出血量。虽然两组患者在术后1年时的功能评分、活动度及返回运动的情况上无显著差异,但改良手术组早期恢复更快,患者满意度更高。同时,改良术式有助于降低神经损伤的发生风险,在保证疗效的同时提升了安全性,是一个潜在的具有推广价值的改良手术。更多还原

【Abstract】 Objective:Bristow-Latarjet procedure is the preferred treatment for recurrent anterior shoulder dislocation with obvious glenoid bone loss.However,it has a relatively high incidence of complications.In order to reduce these risks,we proposed a modified procedure in which the shoulder is positioned at 0°abduction and 90°external rotation during glenoid exposure and graft fixation,and the capsule is repaired with anchors.This study aims to evaluate whether this modification can improve shoulder function,accelerate recovery,reduce nerve injury and help patients return to sports compared to the traditional procedure.Methods:This study selected patients treated between Jan.2022 and Feb.2024because recurrent anterior shoulder dislocation.Patients were randomly assigned to either the modified Latarjet(ML)group or the traditional Latarjet(TL)group and received corresponding procedure.Baseline characteristics and preoperative functional assessments,including range of motion(ROM),Visual Analogue Scale(VAS)scores,Rowe scores,American Shoulder and Elbow Surgeons’Form(ASES),University of California at Los Angeles Shoulder Scale(UCLA)were recorded.Radiological evaluations were conducted to measure the glenoid bone loss and assess whether complicated with Hill-Sachs lesions.Intraoperative data,including operation time and blood loss were also documented.All patients followed a standardized rehabilitation protocol.Functional assessments(ROM,VAS scores,Rowe scores,ASES scores,and UCLA scores)were conducted at 1,3,6,and 12 months postoperatively.At the 12-month follow-up,we also recorded the rates of returning to sports,satisfaction with their sports performance and Shoulder Instability?Return to Sport after Injury(SIRSI)scores.CT scans were performed to evaluate graft position,bone healing,osteolysis and shoulder osteoarthritis at the 1 day,6 months and 1 year postoperatively.Complications were also recorded,when patients were suspected with nerve injury,electromyography was performed to identify the affected nerve.Statistical analysis were performed via Student’s t-test,paired t-test,and chi-square test,with significance set at P<0.05.Results:A total of 38 patients were finally included,with 20 patients in the ML group and 18 patients in the TL group.There were no significant difference between the two groups in terms of baseline characteristics or preoperative functional assessments.Both groups exhibited a decline in functional scores and ROM at 1 month postoperatively,followed by gradual improvements at 3 and 6 months.At 3 and 6months postoperatively,compared to the TL group,ML group showed significantly higher Rowe scores(62.00±8.34 vs.53.61±11.48;83.75±10.37 vs.75.83±11.66),UCLA scores(21.75±2.17 vs.18.56±2.64;26.80±2.38 vs.24.39±2.25)and ASES scores(67.33±7.90 vs.61.39±6.94;77.25±4.96 vs.73.06±6.52)(P<0.05).At the1-year follow-up,all functional scores improved significantly compared to the preoperative data in both groups.Except for loss of external rotation(P>0.05),other ROM parameters showed no significant change.There were no significant differences in the functional scores and ROM between two groups.Patient satisfaction in the ML group(8.20±0.70)was significantly higher than that in the TL group(P<0.05).There were no significant differences between rates of returning to sports,satisfaction with sports performance and SIRSI scores in the two groups.In terms of radiological outcomes,there were no significant differences between two groups.Two cases of nerve injuries were reported in the TL group,one involved was the axillary nerve and the other was suprascapular nerve.They all recovered in 3 months without any after-effects.There were no significant differences in other complications rates between two groups.Conclusion:The modified Bristow-Latarjet procedure improved function outcomes significantly without prolonging operative time or increasing blood loss.Although there was no significant difference between the function outcomes at 1 year postoperatively,patients in the modified group recovered faster and had a higher satisfaction.There were fewer cases of nerve injuries in the modified group.So,this modified procedure,enhances safety while maintaining efficacy,making it a promising alternative for wider clinical application.更多还原