老年陈旧性锁定型盂肱前脱位的镜下治疗△

Arthroscopic treatment of chronic locking anterior glenohumeral dislocation in the elderly

摘要:

［目的］介绍老年陈旧性锁定型盂肱前脱位的镜下治疗手术技术与初步临床效果。［方法］2016 年 1 月—2020 年 12 月，对 5 例陈旧性锁定型患者采用镜下手术治疗。镜下切除瘢痕组织，复位盂肱关节。于 Hill－Sachs 损伤中间置入 2 枚锚钉。暴露盂肱盂前部和下部的骨缺损区域，用刮匙将肩胛盂骨缺损创面新鲜化。取 2 cm×2 cm×1 cm 的双皮质骨块，按受区大小和形状修整。建立前下入路，将骨块置于关节盂前下缘，使用 2 枚空心钛拉力螺钉固定骨块。在肩盂前缘 1~7 点处根据需要置入 2~4 枚锚钉，缝合前方关节囊及盂唇，收紧后方缝线，进行冈下肌填塞；部分病例修复肩袖损伤。［结果］ 5 例患者均顺利完成手术，均无严重并发症。随访 9~18 个月，平均（11.5±3.1）个月。末次随访时前屈上举活动度、ASES、Constant-Murley 和 Rowe 评分均较术前显著改善 （P<0.05）。至末次随访时，所有患者均无盂肱不稳复发，无翻修手术。CT 检查证实植骨已与盂前愈合，盂肱对合良好。［结论］本镜下手术集中体现了关节镜手术的优点，能够有效复位盂肱关节，同时重建关节盂，修复前侧关节囊的 Hill-Sachs 损伤，是治疗慢性锁定型盂肱前脱位的有效方法。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of the arthroscopic treatment of chronic locking anterior glenohumeral dislocation in the elderly. [Methods] From January 2016 to December 2020, 5 elderly patients received ar- throscopic treatment for chronic locking anterior glenohumeral dislocation. The scar tissue was removed arthroscopically and the normal gle- nohumeral alignment was recovered. Two anchors were placed in the middle of bone defect in the Hill-Sachs lesion. The bone defect area of the anteroinferior glenoid was exposed, and freshened with a curettage. A 2 cm×2 cm×1 cm bicortical bone block was harvest from the ili- um and trimmed according to the size and shape of the recipient area. After the anteroinferior approach was established, the bone block was placed on the anteroinferior edge of the glenoid, and fixed with two cannulated lag screws. Two to four anchors were inserted into the anteri- or margin of the glenoid at 1-7 o'clocks as needed, the anterior joint capsule and labrum were sutured. The sutures of the 2 posterior an- chors previously placed were tightened to fill the infraspinatus on the bone defect in the Hill-Sachs lesion, and if necessary, the torn rotator cuff was repaired in some cases. [Results] All 5 patients had arthroscopic procedures performed successfully without serious complications, and followed up for 9~18 months with a mean of (11.5±3.1) months. At last follow-up the range of motion of the shoulder, as well as ASES, Constant-Murley and Rowe scores were significantly improved compared with those preoperatively (P＜0.05) . Up to the latest follow-up, no recurrence of glenohumeral instability and no revision surgery happened in anyone of them. The CT examination confirmed that the bone graft had healed on the anteroinferior glenoid with proper glenohumeral alignment. [Conclusion] This arthroscopic procedure epitomizes the advantages of arthroscopic technique, which does effectively restore the normal glenohumeral alignment, reconstruct the glenoid, repair anterior capsule and the Hill-Sachs lesion, and is an effective method for the treatment of chronic locking anterior glenohumeral dislocation in the elderly.