关节镜下非打结型缝合锚钉修补Bankart损伤治疗复发陛肩关节前脱位

摘要

Objective To investigate the clinical results of arthroscopic Bankart repair for the treatment of recurrent anterior shoulder dislocation with Mitek bioknotless suture anchors.Methods Fourteen patients of recurrent anterior shoulder dislocation were treated by arthroscopic Bankart repair with Mitek bioknotless suture anchors.All patients had unidirectional instabilities on the dominant sides.The average age at surgery was 25.2 years (range,18-34 years).The mean times of dislocations before surgery were 13.5 (range,3-36).American Shoulder and Elbow Surgeons(ASES) and Constant-Murley score were adopted for final evaluation at the last follow-up.Results The mean follow-up period was 17 months (range,11-22 months).A Hill-Sachs lesion was observed in 9 patients.A bony Bankart lesion was found in 3 patients.A type Ⅱ SLAP lesion was associated in 2 patients and treated with arthroscopie fixation.A posterior-inferior labral lesion was found in 2 patients and treated with arthroseopic debridement.A joint mouse was removed in 1 patient.The mean forward flexion was 163.4°±8.6° and 169.7°± 4.2° pre-and postoperatively.The mean external rotation in 90° abduction was 58.5°±13.6° and 90.30°±5.5°pre-and postoperatively,which was less 8.40°±6.2° than that of normal side shoulder postoperatively.The pre-and postoperative mean ASES score was 77.4±3.7 and 94.3±2.6,the mean VAS instability score were 7.2±1.4 and 1.2±0.6.The pre-and postoperative mean Constant-Murley score was 78.1 ±4.6 and 93.9±3.7.All patients did not suffer postoperative s houlder dislocation.All patients returned to their pre-injury works.Conclusion Arthroseopic Bankart repair with Mitek bioknotless suture anchors is a good option for treating recurrent anterior shoulder dislocation.%目的 探讨关节镜下非打结型缝合锚钉修补Bankan损伤治疗复发性肩关节前脱位的疗效.方法 复发性肩关节前脱位患者14例,均为男性;年龄18～34岁,平均25.2岁;左侧4例,右侧10例,涉及主力侧12例;均为单向不稳.术前脱位次数为3～36次,平均13.5次.关节镜下采用可吸收非打结型缝合锚钉治疗Bankart损伤.术前及术后随访采用ASES评分及Constant-Murley功能评估.结果 所有患者均获得随访,随访时间11～22个月,平均17个月.术中发现9例合并Hill-Sachs损伤,3例合并骨性Bankart损伤,2例合并后下盂唇损伤,2例合并SLAPⅡ型损伤,1例合并关节内游离体.14例患者术前及末次随访时肩关节平均前屈上举为163.4°±8.6°和169.7°±4.2°;外展90°时,平均外旋角度分别为58.5°+13.6°和90.3 °±5.5.;术后外展90°时,患侧外旋角度较健侧受限8.4°±6.2°术前及末次随访时ASES评分为(77.4±3.7)分和(94.3±2.6)分,两者比较差异有统计学意义(P＜0.05);其中VAS不稳定评分平均为(7.2±1.4)分和(1.2 ±0.6)分(P＜0.01);Constant-Mudey评分平均为(78.1±4.6)分和(93.9±3.7)分.术后无一例患者发生再脱位,且均重返伤前工作岗位.结论 肩关节镜下Bankart 重建手术是治疗复发性肩关节脱位的有效方法 .非打结型缝合锚钉简化了手术操作步骤,减少手术时间和创伤.