Bajracharya A R, Anjum M P
Department of Orthopaedics, Bir hospital and Capital Hospital, Kathmandu, Nepal.
JNMA J Nepal Med Assoc. 2007 Oct-Dec;46(168):189-93.
Shoulder dislocation is common problem in orthopaedics. Management of recurrent shoulder dislocation is painstaking with different surgical procedures having varying outcomes. Laterjet-Bristow procedure provides stability and good functional outcome in Rowe scale and long term patient satisfaction. This is an observational prospective study carried out at two different tertiary care centers at Nepal and Pakistan using the same protocol. Habitual and pathological recurrent dislocations were excluded and all the recurrent dislocation of shoulder following initial traumatic anterior dislocation was included in this study. Standard Laterjet-Bristow operation was done and followed up for average of 27 months. Functional evaluation was done using Rowe score and graded as excellent, good, fair and poor. There were 12 men and 9 women with the mean ages of 23.4 years. At 12 months, 11 patients had fair result and seven patients had good result. At two years only three had fair result, 15 had good result and three patients had excellent result. Only three patients had poor result at one year while none had poor result at two year. The mean loss of external rotation in operated shoulder at one year was 24.33 degrees which decreased to 21.2 degrees at the end of second year. There was no restriction of external rotation in three patients at both yearly follow-ups while 18 patients had restriction in the range 10-30 degrees. Laterjet-Bristow can be the procedure of choice for surgical treatment of recurrent traumatic anterior dislocation and also as a salvage surgery for failed cases from other types of procedures. The only shortcoming of this procedure was some limitation in external rotation and minor loss in muscle power of that shoulder.
肩关节脱位是骨科常见问题。复发性肩关节脱位的治疗颇为棘手，不同手术方式的效果各异。莱泰杰 - 布里斯托手术在罗伊评分中能提供稳定性并带来良好的功能预后，患者长期满意度较高。这是一项在尼泊尔和巴基斯坦的两家不同三级医疗中心按照相同方案开展的观察性前瞻性研究。习惯性和病理性复发性脱位被排除在外，本研究纳入了所有初次创伤性前脱位后出现的复发性肩关节脱位病例。实施了标准的莱泰杰 - 布里斯托手术，并平均随访27个月。使用罗伊评分进行功能评估，分为优、良、中、差四个等级。研究对象有12名男性和9名女性，平均年龄为23.4岁。在术后12个月时，11例患者结果为中，7例患者结果为良。到两年时，只有3例结果为中，15例结果为良，3例患者结果为优。术后一年仅有3例患者结果为差，而两年时无患者结果为差。术后一年患侧肩部外旋平均丧失24.33度，到第二年年底降至21.2度。在每年的随访中，有3例患者双侧外旋均无受限，而18例患者外旋受限范围在10 - 30度之间。莱泰杰 - 布里斯托手术可作为复发性创伤性前脱位手术治疗的首选方法，也可作为其他手术方式失败后的挽救性手术。该手术唯一的缺点是外旋存在一定限制，且患侧肩部肌肉力量有轻微丧失。
