改良线袢法Latarjet技术治疗肩关节复发性脱位的中期疗效及移植骨块塑形模式分析*
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许鉴,E-mail:jame_0615@163.com

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广东省自然科学基金(No:2018A030310646)


Mid-term efficacy of the treatment of recurrent shoulder joint dislocation using modified suture-button Latarjet technique and analysis of grafts remodeling mode*
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    摘要:目的 线袢法固定Latarjet手术效果好,但无中长期疗效的报道。该研究首次报道线袢法Latarjet术后中期效果。方法 回顾改良线袢法Latarjet手术患者152例,术后随访观察关节活动度、视觉模拟评分(VAS)、Rowe评分、Walch-Duplay评分和美国肩肘外科评分(ASES)。通过X片和CT扫描评估骨块位置、愈合情况及肩关节退变情况。结果 术后平均随访(35.3±5.8)个月,所有患者肩关节恢复良好、骨块完全愈合,无复发。术后VAS、Rowe、ASES和Walch-Duplay评分明显改善。术后三维CT扫描En-face位显示,骨块中心平均位于约4点钟位置。146例骨块正常,2例过高,4例骨块过低。术后即刻CT横断面观察,移位骨块与关节盂相平134例,偏外16例,偏内2例。喙突移位骨块出现了不同程度的骨吸收现象,术后平均1年内达到稳定,呈“圆外吸收”现象。全部移植骨块的骨质存在向上、下延伸爬行塑形现象。术后并发症发生率仅为1.3%,全部病例未出现肩关节退变情况。结论 线袢固定Latarjet中期疗效好,可有效避免关节盂退变的并发症,移植骨块随访过程中呈“圆外吸收”特点,塑形呈延伸爬行现象,最终关节盂与骨块融合塑形成正梨形关节盂。

    Abstract:

    Abstract: Objective The suture button Latarjet technique has been proved for excellent efficacy, however, the mid-term results are lacking. This study is to investigate the efficacy of suture button Latarjet procedure with mid-term follow-up. Methods A total of 152 patients who underwent suture button Latarjet operation were enrolled in this study. Range of motion, VAS score, Rowe score, Walch-Duplay and ASES score were followed postoperatively. Meanwhile, the graft position, healing condition of coracoid grafts and the arthropathy of glenoid and humeral head were also assessed according to the X-ray and three-dimensional computed tomograph scans. Results The mean follow-up time duration is (35.3 ± 5.8) months. All the patients recovered well, all grafts healed and no redislocation occurred. The mean visual analog scale score for instability during motion, the ASES score, Rowe Score and Walch-Duplay score all improved significantly. Immediate postoperatively, the average graft midline center is at 4 o'clock at the e-face view, 146 cases positioned normally, 2 cases superiorly and 4 cases inferiorly. At the axial view, the CT scans showed 134 cases were flush to the glenoid, 2 cases and 16 cases positioned medially and laterally respectively. The coracoid graft showed different degrees of bone resorption, which reached a stable level within an average of 1 year after operation, showing an “out of circle” absorption phenomenon. All bone grafts exhibited upward and downward extension, creeping and shaping. No complication and arthropathy was found. Conclusion The suture button Latarjet technique has achieved an excellent clinical effect and can effectively avoid the complications of joint arthropathy. During the follow-up, the graft showed the characteristics of “out of circle” absorption phenomenonand extended creeping. Finally, the glenoid was fused with the graft to form a pyriform glenoid.

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柳海峰,陆伟,许鉴,朱伟民,邓桢翰,欧阳侃,梁达强,王大平.改良线袢法Latarjet技术治疗肩关节复发性脱位的中期疗效及移植骨块塑形模式分析*[J].中国内镜杂志,2019,25(6):1-8

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  • 收稿日期:2019-04-01
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  • 在线发布日期: 2019-06-30
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