Resch H, Golser K, Thoeni H, Sperner G
Department of Traumatology, University Hospital of Innsbruck, Innsbruck, Austria.
J Shoulder Elbow Surg. 1993 May;2(3):147-55. doi: 10.1016/S1058-2746(09)80051-7. Epub 2009 Feb 19.
Complete detachment of the glenoid labrum from the superior pole of the glenoid, which is associated with a destabilization of the origin of the long biceps tendon, leads to altered function in the shoulder joint. This is especially noticeable when the shoulder is used in overhead activities. Two operative techniques are described for reattachment of the glenoid labrum to the glenoid. In the first six patients the glenoid labrum was reattached with small cannulated titanium screws. In five patients these screws were inserted under arthroscopic control from a cranial direction. The labrum was always reattached just behind the origin of the long biceps tendon. The most favorable portal was identified by percutaneous probing with a Kirschner wire. If the superior glenoid pole could not be reached via a portal placed anterior or medial to the acromion, a hole was drilled through the acromion, and a transacromial approach was used. The screws were removed by arthroscopy after 3 to 5 months. In the last eight patients, absorbable tacks were used instead of screws. Of 18 patients who showed a complete detachment of the glenoid labrum from the superior pole of the glenoid with destabilization of the attachment of the biceps tendon, 14 underwent reattachment as described previously. The minimum follow-up time was greater than 6 months (mean follow-up time 18 months, maximum follow-up time 30 months). At follow-up, eight patients felt completely rehabilitated and had resumed their previous overhead activities (overhead sports). Four patients believed their conditions were improved. Two patients had not experienced any improvement. Of the patients who had not undergone reattachment and who had undergone shaving of the free margin of the glenoid labrum, only one had experienced improvement, while the other three patients did not report any improvement.
肩胛盂唇从肩胛盂上极完全分离，这与肱二头肌长头肌腱起点不稳定相关，会导致肩关节功能改变。当肩部进行过顶活动时，这种情况尤为明显。本文描述了两种将肩胛盂唇重新附着于肩胛盂的手术技术。在前6例患者中，使用小型空心钛螺钉将肩胛盂唇重新附着。在5例患者中，这些螺钉在关节镜控制下从颅侧方向插入。肩胛盂唇总是重新附着在肱二头肌长头肌腱起点的后方。通过用克氏针经皮探查确定最有利的入路。如果无法通过位于肩峰前方或内侧的入路到达肩胛盂上极，则在肩峰上钻孔，并采用经肩峰入路。3至5个月后通过关节镜取出螺钉。在最后8例患者中，使用可吸收钉代替螺钉。18例肩胛盂唇从肩胛盂上极完全分离且肱二头肌肌腱附着不稳定的患者中，14例按上述方法进行了重新附着。最短随访时间大于6个月（平均随访时间18个月，最长随访时间30个月）。随访时，8例患者感觉完全康复并已恢复之前的过顶活动（过顶运动）。4例患者认为病情有所改善。2例患者没有任何改善。在未进行重新附着且对肩胛盂唇游离缘进行了修整的患者中，只有1例病情有所改善，而其他3例患者未报告任何改善。
