镜下与开放手术治疗老年复发性肩关节前脱位

Arthroscopic versus open procedures for recurrent anterior shoulder dislocation in the elderly

摘要:

［目的］比较镜下与开放手术治疗老年复发性肩关节前脱位的临床效果。［方法］回顾性分析 2015 年 5 月—2019 年 4 月手术治疗的老年创伤性复发性肩关节前脱位共 88 例患者的临床资料，男 35 例，女 53 例，平均年龄（65.21±5.64）岁。依据术前医患沟通结果，22 例采用镜下修复手术，66 例采用传统开放性修复手术。［结果］两组均顺利完成手术。镜下组手术时间、术中出血量、术后引流量及住院时间均显著优于开放组 （P<0.05）。随访期间，两组患者均无再次脱位。镜下组恢复完全负重活动时间显著早于开放组 （P<0.05）。随术后时间推移，两组患者 VAS 评分均显著下降 （P<0.05），而 Neer 和 ConstantMurley 评分均显著增加 （P<0.05）。术后 6 个月和末次随访时，镜下组 VAS、Neer 和 Constant-Murley 评分均显著优于开放组 （P<0.05）。［结论］对于老年复发性肩关节前脱位，镜下同时修复 Bankart 损伤和肩袖破裂的临床效果优于开放手术。

Abstract:

[Objective] To compare the clinical outcomes of arthroscopic versus open repairs for recurrent anterior shoulder dislocation in the elderly. [Methods] A retrospective study was conducted on 88 elderly patients, including 35 males and 53 females, aged (65.21± 5.64) years, who underwent surgical treatment for traumatic recurrent anterior dislocation of the shoulder in our hospital from May 2015 to April 2019. According to the results of preoperative doctor-patient communication, 22 patients had the Bankart lesion and rotator cuff tear repaired arthroscopically, while the other 66 patients underwent traditional open repair surgery. [Results] The patients in both groups had operations completed successfully. The arthroscopic group proved significantly superior to the open group in term of operation time, intraop- erative blood loss, postoperative drainage and hospital stay (P＜0.05) . During the follow-up, no further dislocation of shoulder happened in anyone in both groups. The arthroscopic group resumed full weight-bearing activity significantly earlier than the open group (P＜0.05) . The VAS scores decreased significantly (P＜0.05) , while the Neer and Constant-Murley scores increased significantly over time postoperatively in both groups (P＜0.05) . At 6 months after operation and the latest follow-up, the arthroscopic group was significantly superior to the open group regarding VAS, Neer, and Constant-Murley scores (P＜0.05) . [Conclusion] For recurrent anterior shoulder dislocation in the elderly, the arthroscopic technique is better than the open counterpart in term of the clinical results of simultaneous repair of Bankart injury and ro- tator cuff tear.