【摘 要】 目的 通過分析肩關(guān)節(jié)前脫位次數(shù)、病程與關(guān)節(jié)內(nèi)繼發(fā)損傷的關(guān)系，探討復(fù)發(fā)性肩關(guān)節(jié)前脫位對(duì)關(guān)節(jié)內(nèi)繼發(fā)損傷的影響。 方法 回顧分析2005年1月－2009年6月關(guān)節(jié)鏡下應(yīng)用縫合錨釘行Bankart重建術(shù)治療的59例復(fù)發(fā)性肩關(guān)節(jié)前脫位患者臨床資料。男48例，女11例；年齡15～42歲，平均27.6歲。初次脫位原因：接觸性體育運(yùn)動(dòng)21例，非接觸性體育運(yùn)動(dòng)13例，日?；顒?dòng)11例，外傷14例。術(shù)前脫位3～32次，平均10.6次。初次脫位至手術(shù)時(shí)間為11個(gè)月～12年，中位時(shí)間5.9年?；颊呖謶衷囼?yàn)及復(fù)位試驗(yàn)均呈陽(yáng)性。術(shù)前美國(guó)加州大學(xué)洛杉磯分校（UCLA）肩關(guān)節(jié)功能評(píng)分為（22.3 ± 2.4）分，Constant-Murley評(píng)分為（73.1 ± 5.8）分。關(guān)節(jié)鏡下觀察關(guān)節(jié)內(nèi)繼發(fā)損傷情況，并進(jìn)行統(tǒng)計(jì)分析。 結(jié)果 術(shù)后患者切口均Ⅰ期愈合。患者均獲隨訪，隨訪時(shí)間16～58個(gè)月，平均37.3個(gè)月。末次隨訪時(shí)，UCLA肩關(guān)節(jié)功能評(píng)分為（34.6 ± 1.7）分，Constant-Murley評(píng)分為（86.7 ± 6.1）分，與術(shù)前比較差異均有統(tǒng)計(jì)學(xué)意義（P lt; 0.05）。術(shù)前關(guān)節(jié)脫位次數(shù)和關(guān)節(jié)軟骨損傷的嚴(yán)重程度成正相關(guān)（rs=0.345，P=0.007），和Hill-Sachs損傷嚴(yán)重程度成正相關(guān)（rs=0.708，P=0.000）；首次脫位至手術(shù)時(shí)間和關(guān)節(jié)軟骨損傷嚴(yán)重程度成正相關(guān)（rs=0.498，P=0.000），與Hill-Sachs損傷嚴(yán)重程度無(wú)相關(guān)性（rs=0.021，P=0.874）。 結(jié)論 復(fù)發(fā)性肩關(guān)節(jié)前脫位早期行Bankart重建有利于肩關(guān)節(jié)功能恢復(fù)，避免或延緩關(guān)節(jié)內(nèi)繼發(fā)損傷的發(fā)生和發(fā)展。
引用本文： 李海峰,劉玉杰,李眾利,李春寶,董曉艷,朱娟麗,劉洋. 復(fù)發(fā)性肩關(guān)節(jié)前脫位與關(guān)節(jié)內(nèi)繼發(fā)損傷的相關(guān)性研究. 中國(guó)修復(fù)重建外科雜志, 2012, 26(3): 308-312. doi: 復(fù)制
| 1. | Hayes K, Callanan M, Walton J, et al. Shoulder instability: management and rehabilitation. J Orthop Sports Phys Ther, 2002, 32(10): 497-509. |
| 2. | Deitch J, Mehlman CT, Foad SL, et al. Traumatic anterior shoulder dislocation in adolescents. Am J Sports Med, 2003, 31(5): 758-763. |
| 3. | Yiannakopoulos CK, Mataragas E, Antonogiannakis E. A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Arthroscopy, 2007, 23 (9): 985-990. |
| 4. | Calandra JJ, Baker CL, Uribe J. The incidence of Hill-Sachs lesions in initial anterior shoulder dislocations. Arthroscopy, 1989, 5(4): 254-257. |
| 5. | Cameron ML, Kocher MS, Briggs KK, et al. The prevalence of glenohumeral osteoarthrosis in unstable shoulder. Am J Sports Med, 2003, 31(1): 53-55. |
| 6. | Snyder SJ, Banas MP, Karzel RP, et al. An analysis of 140 injuries to the superior glenoid labrum. J Shoulder Elbow Surg, 1995, 4(4): 243-248. |
| 7. | Brophy RH, Marx RG. The treatment of traumatic anterior instability of the shoulder: nonoperative and surgical treatment. Arthroscopy, 2009, 25(3): 298-304. |
| 8. | Handoll HH, Almaiyah MA, Rangan A. Surgical versus non-surgical treatment for acute anterior shoulder dislocation. Cochrane Database Syst Rev, 2004, (1): CD004325. |
| 9. | 朱獻(xiàn)忠, 黃富國(guó). 盂肱韌帶維持肩關(guān)節(jié)前方穩(wěn)定性生物力學(xué)研究. 中國(guó)修復(fù)重建外科雜志, 2007, 21(11): 1175-1178. |
| 10. | Taylor DC, Arciero RA. Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first-time, traumatic anterior dislocations. Am J Sports Med, 1997, 25(3): 306-311. |
| 11. | Marx RG, McCarty EC, Montemurno TD, et al. Development of arthrosis following dislocation of the shoulder: a case-control study. J Shoulder Elbow Surg, 2002, 11(1): 1-5. |
| 12. | Cheung EV, Sperling JW, Hattrup SJ, et al. Long-term outcome of anterior stabilization of the shoulder. J Shoulder Elbow Surg, 2008, 17(2): 265-270. |
| 13. | Larrain MV, Montenegro HJ, Mauas DM, et al. Arthroscopic management of traumatic anterior shoulder instability in collision athletes: analysis of 204 cases with a 4- to 9-year follow-up and results with the suture anchor technique. Arthroscopy, 2006, 22(12): 1283-1289. |
| 14. | Kim TK, Queale WS, Cosgarea AJ, et al. Clinical features of the different types of SLAP lesions: an analysis of one hundred and thirty-nine cases. J Bone Joint Surg (Am), 2003, 85-A(1): 66-71. |
| 15. | Porcellini G, Paladini P, Campi F, et al. Shoulder instability and related rotator cuff tears: arthroscopic findings and treatment in patients aged 40 to 60 years. Arthroscopy, 2006, 22 (3): 270-276. |
| 16. | 劉玉杰, 周密, 李光輝, 等. 肩關(guān)節(jié)脫位合并肩袖與Bankart損傷的診治. 中華創(chuàng)傷骨科雜志, 2008, 10(10): 915-918. |
| 17. | Law BK, Yung PS, Ho EP, et al. The surgical outcome of immediate arthroscopic Bankart repair for first time anterior shoulder dislocation in young active patients. Knee Surg Sports Traumatol Arthrosc, 2008, 16 (2): 188-193. |
- 1. Hayes K, Callanan M, Walton J, et al. Shoulder instability: management and rehabilitation. J Orthop Sports Phys Ther, 2002, 32(10): 497-509.
- 2. Deitch J, Mehlman CT, Foad SL, et al. Traumatic anterior shoulder dislocation in adolescents. Am J Sports Med, 2003, 31(5): 758-763.
- 3. Yiannakopoulos CK, Mataragas E, Antonogiannakis E. A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Arthroscopy, 2007, 23 (9): 985-990.
- 4. Calandra JJ, Baker CL, Uribe J. The incidence of Hill-Sachs lesions in initial anterior shoulder dislocations. Arthroscopy, 1989, 5(4): 254-257.
- 5. Cameron ML, Kocher MS, Briggs KK, et al. The prevalence of glenohumeral osteoarthrosis in unstable shoulder. Am J Sports Med, 2003, 31(1): 53-55.
- 6. Snyder SJ, Banas MP, Karzel RP, et al. An analysis of 140 injuries to the superior glenoid labrum. J Shoulder Elbow Surg, 1995, 4(4): 243-248.
- 7. Brophy RH, Marx RG. The treatment of traumatic anterior instability of the shoulder: nonoperative and surgical treatment. Arthroscopy, 2009, 25(3): 298-304.
- 8. Handoll HH, Almaiyah MA, Rangan A. Surgical versus non-surgical treatment for acute anterior shoulder dislocation. Cochrane Database Syst Rev, 2004, (1): CD004325.
- 9. 朱獻(xiàn)忠, 黃富國(guó). 盂肱韌帶維持肩關(guān)節(jié)前方穩(wěn)定性生物力學(xué)研究. 中國(guó)修復(fù)重建外科雜志, 2007, 21(11): 1175-1178.
- 10. Taylor DC, Arciero RA. Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first-time, traumatic anterior dislocations. Am J Sports Med, 1997, 25(3): 306-311.
- 11. Marx RG, McCarty EC, Montemurno TD, et al. Development of arthrosis following dislocation of the shoulder: a case-control study. J Shoulder Elbow Surg, 2002, 11(1): 1-5.
- 12. Cheung EV, Sperling JW, Hattrup SJ, et al. Long-term outcome of anterior stabilization of the shoulder. J Shoulder Elbow Surg, 2008, 17(2): 265-270.
- 13. Larrain MV, Montenegro HJ, Mauas DM, et al. Arthroscopic management of traumatic anterior shoulder instability in collision athletes: analysis of 204 cases with a 4- to 9-year follow-up and results with the suture anchor technique. Arthroscopy, 2006, 22(12): 1283-1289.
- 14. Kim TK, Queale WS, Cosgarea AJ, et al. Clinical features of the different types of SLAP lesions: an analysis of one hundred and thirty-nine cases. J Bone Joint Surg (Am), 2003, 85-A(1): 66-71.
- 15. Porcellini G, Paladini P, Campi F, et al. Shoulder instability and related rotator cuff tears: arthroscopic findings and treatment in patients aged 40 to 60 years. Arthroscopy, 2006, 22 (3): 270-276.
- 16. 劉玉杰, 周密, 李光輝, 等. 肩關(guān)節(jié)脫位合并肩袖與Bankart損傷的診治. 中華創(chuàng)傷骨科雜志, 2008, 10(10): 915-918.
- 17. Law BK, Yung PS, Ho EP, et al. The surgical outcome of immediate arthroscopic Bankart repair for first time anterior shoulder dislocation in young active patients. Knee Surg Sports Traumatol Arthrosc, 2008, 16 (2): 188-193.