Omidi-Kashani Farzad, Sadri-Mahvelati Eghbal, Mazlumi Seyed-Mahdi, Makhmalbaf Hadi
Department of Orthopedics, Qaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Arch Iran Med. 2008 May;11(3):270-3.
The treatment of recurrent anterior shoulder dislocation in patients who failed a supervised rehabilitation program is operative stabilization. Anatomical repair addressing the underlying pathology is the preferred method. We hypothesize that Bristow-Latarjet procedure is effective in all types of traumatic recurrent anterior shoulder dislocations, although in cases with Bankart lesion, Bankart operation is certainly preferred.
Thirty-five shoulders on which a Bristow-Latarjet operation had been performed on account of traumatic recurrent anterior shoulder instability were followed up for an average of 24.6 months (range: 18 - 51). The clinical outcome was measured according to Walch-Duplay Rating Sheet for Anterior Instability of the Shoulder at the latest follow-up.
The clinical outcome was excellent in 11 (317%) patients and good in 24 (69%) patients. Two patients had redislocation that were treated nonoperatively and remained symptom-free at the latest follow-up. Radial nerve palsy occurred in one patient that spontaneously recovered after nine weeks.
Although the treatment of anterior shoulder instability in patients with Bankart lesion and intact capsular material (without excessive laxity) is certainly Bankart operation, we claim that in almost all types of anterior shoulder instability, especially in patients with large Hill-Sachs lesions, glenoid bone loss, or excessive capsular laxity, the Bristow-Latarjet operation is associated with good or excellent results and can make the patient satisfied.
对于经过监督康复计划治疗失败的复发性前肩关节脱位患者，手术稳定治疗是首选。针对潜在病理改变的解剖修复是首选方法。我们假设，尽管对于存在Bankart损伤的病例，Bankart手术无疑是首选，但Bristow-Latarjet手术对于所有类型的创伤性复发性前肩关节脱位均有效。
对35例因创伤性复发性前肩关节不稳而接受Bristow-Latarjet手术的肩关节进行平均24.6个月（范围：18 - 51个月）的随访。在最近一次随访时，根据Walch-Duplay肩关节前不稳定评分表评估临床结果。
11例（31.7%）患者临床结果为优，24例（69%）患者为良。2例患者出现再脱位，接受非手术治疗，在最近一次随访时仍无症状。1例患者发生桡神经麻痹，9周后自行恢复。
尽管对于存在Bankart损伤且关节囊材料完整（无过度松弛）的前肩关节不稳患者，Bankart手术无疑是首选，但我们认为，在几乎所有类型的前肩关节不稳中，尤其是对于存在大的Hill-Sachs损伤、肩胛盂骨缺损或关节囊过度松弛的患者，Bristow-Latarjet手术的效果良好或极佳，能使患者满意。
