全关节镜下手术治疗骨性Bankart损伤的术后疗效分析

摘要

Objective To investigate the shoulder function after arthroscopic reduction and internal fixation in patients with bony Bankart lesion.Methods Between May 2004 and May 2008,45 patients with bony Bankart lesion who were treated with all arthroscopic reduction and internal fixation with metal anchors were included in this study.Among them 40 patients were male and 5 patients were female.The average age at the surgery was 27.6 years(16.5-50.1 years).The average duration of follow-up was 29.7 months (24.8-49.0 months).A history of recurrent dislocation of affected shoulder was found in all patients.Metal anchors were used to fix the bony Bankart lesion during the surgery.Hill-Sachs remplissage technique was used to treat the Engaging Hill-Sachs lesion.The preoperative American Shoulder and Elbow Society(ASES)score,Constant-Murley score,Rowe score and the VAS score for instability were 84 ±14,95.1 ±4.6,39.4± 2.9 and 5 ± 3 respectively.Results No significant change was found regarding active forward elevation,external rotation and internal rotation after the surgery.The ASES score,Constant-Murley score,Rowe score and the VAS score of stability were 95 ±7,98.3 ±2.2,84.5 ±22.0 and 1 ±2,improved significantly higher after the surgery(P＜0.01).One subluxation and 3 redislocation were happened during follow-up.The overall failure rate was 8.9%(4/45).Conclusions All arthroscopic reduction and fixation of bony Bankart lesion can achieve a good result.%目的 探讨肩关节镜下金属缝合锚钉固定治疗骨性Bankart损伤的术后疗效.方法 2004年5月至2008年5月共收治45例存在肩关节骨性Bankart损伤的患者,均应用全关节镜下复位,金属缝合锚钉固定术治疗.其中男性40例,女性5例.手术时平均年龄27.6岁(16.5～50.1岁),平均随访时间29.7个月(24.8～49.0个月).所有患者术前均有肩关节复发性前脱位病史.术前患者美国肩肘外科协会评分系统(ASES)肩关节评分平均(84 ±14)分,Constant-Murley评分(95.1±4.6)分,Rowe评分(39.4±2.9)分,肩关节稳定性VAS评分(5±3)分.手术中采用金属缝合锚钉进行肩盂前缘骨块的固定.结果 45例患者术后肩关节前屈上举、体侧外旋及内旋活动度较术前比较差异无统计学意义(P＞0.05).术后ASES肩关节评分平均(95±7)分,与术前比较差异具有统计学意义(P＜0.01);Constant-Murley评分平均为(98.3±2.2)分,与术前比较差异具有统计学意义(P=0.011);Rowe评分平均(84.5±22.0)分(P＜0.01),VAS不稳定评分平均为(1±2)分,较术前比较差异具有统计学意义(P＜0.01).末次随访时1例患者曾出现半脱位,3例患者曾有复发脱位,手术失效率为8.9%(4/45).结论 采用全关节镜下置入缝合锚钉对肩盂前缘折块进行复位固定的方法可有效的治疗骨性Bankart损伤.