点位锚钉置入修复Bankart损伤的手术技巧

Surgical technique of anchor placement at 6 o'clock position for repair of Bankart lesion

摘要:

［目的］ 介绍关节镜下 6 点钟位锚钉置入盂唇缝合治疗肩关节前方不稳的手术技巧和临床疗效。［方法］ 2018 年 1 月 1 日—2021 年 1 月 1 日，对 51 例成人肩关节脱位采用四入路技术进行关节镜下后方 Remplissage 修复与前方 Bankart 修复术。建立前上入路尽可能偏上，前下入路用止血钳测试能否到达 6 点位，2 个入路不可太近。松解前方盂唇复合体至 6 点甚至后方 7 点位，盂缘表面去软骨 5 mm。置入 6 点位锚钉，尽量全层修复盂唇复位体。［结果］所有患者均顺利完成手术，无严重术中并发症，随访 12~24 个月。所有患者均未再次出现肩关节脱位。末次随访时 ASES 评分、Constant-Murley 评分和 Rowe 均较术前显著改善（P<0.05）。术后常规复查三维 CT 提示锚钉位置良好。［结论］关节镜下 6 点钟位锚钉置入盂唇缝合治疗盂肱关节不稳手术效果良好。手术的成功有赖于术前严格把握适应证，术中关节镜下操作技术的熟练程度。

Abstract:

[Objective] To introduce the surgical technique and clinical efficacy of arthroscopic anchor placement at 6 o'clock position for anterior shoulder instability. [Methods] From January 1, 2018 to January 1, 2021, 51 adult patients underwent arthroscopic posterior Remplissage procedure and anterior Bankart repair for shoulder dislocation by using four- approach technique. The anterosuperior ap- proach should be as upward as possible, whereas the anteroinferior approach should be tested with hemostatic forceps to confirm if it can reach the 6 o 'clock position and the two approaches should not be too close. The anteriorly labial complex was released to 6 or even 7 o 'clock position, and 5mm cartilage was removed from the anteroinferior glenoid edge. As anchors placed, including the one at 6 o'clock posi- tion, the labrum complex was reduced and repaired in full thickness as possible. [Results] All patients were successfully operated on with- out serious intraoperative complications and were followed up for 12 to 24 months. No shoulder dislocation occurred again in any of the pa- tients. At last follow-up ASES score, Constant-Murley score and Rowe were significantly improved compared with those before operation (P＜0.05) . Postoperative routine three-dimensional CT showed that the anchor position was good. [Conclusion] Arthroscopic anchor place- ment at 6 o 'clock position for repair of labrum complex is effective treatment of glenohumeral instability, which depends on the precise pre- operative selection of indications and the proficiency of the operation technique under the arthroscope.