Wang Yu-bin, Wang Hui-fang, Li Guo-ping, Lu Qing-you, Li Guo-feng
Department of Orthopaedics, Shanghai East Hospital Affiliated to Tongji University, Shanghai 200120, China.
Zhonghua Wai Ke Za Zhi. 2006 Dec 15;44(24):1683-5.
To study the principle of arthroscopic surgery and its clinical importance on the traumatic anterior shoulder instability.
From September 2002 to May 2005, 18 patients with injury history of 15 weeks averagely, were involved in the study. Twelve of the patients had a history of sports injuries, 5 had shoulder injuries during working time, and 1 had a traffic accident. Among them, 18 had shoulder pain, 15 had limitation of range of motion (ROM) of shoulder, 18 had positive apprehension test and 5 had positive speed test. Three patients had Hill-Satch lesion in X-ray. Double contrast CT: I degree: 1; II degree: 15; III degree: 2. On arthroscopic view, 18 had anterior glenoid labrum detachment, 4 had anterior capsular laxity, 4 had combined superior labral anterior posterior (SLAP) injury, 3 had free body, 2 had humeral head or glenoid cartilage lesion. Anterior glenoid labrum detachment in 18 patients was reduced and sutured by the fixed anchor technique, 3 had anterior capsule shrinkage, 2 had debridement of frayed long head tendon of biceps, and 2 had reattachment of the long head tendon of biceps outside the capsule. SLAP injuries were sutured in 3 and debridement of frayed superior labrum in 1.
All of the patients were followed up with an average of 18 months (10 - 32 months). All the patients felt free of the pain of their shoulder, except one felt shoulder aching after strenuous exercise. The loss of the external-rotation of the operated shoulder was less than 20 degrees in 2 patients and the posterior extension was 10 degrees in 1 patient. One patient had a positive result of Apprehension Sign. UCLA score: 14 +/- 3 preoperatively, 32 +/- 5 postoperatively (t = 14.081, P < 0.01). All patients returned to pre-injured sports activities and original work.
Traumatic anterior shoulder instability can obtain good effects when treated with the arthroscopic surgery of shoulder. Complete reduction, and reliable fixation of the anterior glenoid labrum complex is the key point. Fixation with the suture anchor is reliable and makes the operation simple.
研究关节镜手术治疗创伤性肩关节前不稳定的原理及其临床意义。
选取2002年9月至2005年5月间平均受伤史15周的18例患者。其中12例有运动损伤史，5例在工作时肩部受伤，1例有交通事故史。18例均有肩部疼痛，15例有肩关节活动范围（ROM）受限，18例恐惧试验阳性，5例Speed试验阳性。X线检查3例有Hill-Satch损伤。双重对比CT：Ⅰ度1例；Ⅱ度15例；Ⅲ度2例。关节镜下可见，18例有前盂唇撕裂，4例有前关节囊松弛，4例合并上盂唇前后（SLAP）损伤，3例有游离体，2例有肱骨头或盂软骨损伤。18例前盂唇撕裂采用锚钉固定技术复位缝合，3例进行前关节囊紧缩，2例对磨损的肱二头肌长头腱进行清创，2例将肱二头肌长头腱在关节囊外重新附着。3例SLAP损伤进行缝合，1例对上盂唇磨损处进行清创。
所有患者平均随访18个月（10 - 32个月）。除1例剧烈运动后肩部仍有疼痛外，其余患者肩部疼痛均消失。2例患侧肩关节外旋丢失小于20度，1例后伸丢失10度。1例恐惧试验阳性。UCLA评分：术前14±3分，术后32±5分（t = 14.081，P < 0.01）。所有患者均恢复到受伤前的体育活动和原来的工作。
创伤性肩关节前不稳定采用肩关节镜手术治疗可取得良好效果。前盂唇复合体的完全复位和可靠固定是关键。锚钉固定可靠且操作简单。
