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关节镜下治疗全层肩盂唇撕裂的疗效。

Outcomes of arthroscopic repair of panlabral tears of the glenohumeral joint.

机构信息

Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Ohio, USA.

出版信息

Am J Sports Med. 2012 Nov;40(11):2561-8. doi: 10.1177/0363546512460834. Epub 2012 Sep 28.

Abstract

BACKGROUND

Combined lesions of the glenoid labrum involving tears of the anterior, posterior, and superior labrum have been infrequently reported in the literature.

PURPOSE

To evaluate the clinical outcomes of arthroscopic repair of these lesions in a general population using validated scoring instruments, presence of complications, and need for revision surgery.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Fifty-eight patients who had arthroscopic labral repair of tears involving the anterior, posterior, and superior labrum (defined as a panlabral repair) were identified at our institution by retrospective review. All patients underwent arthroscopic labral repair with suture anchor fixation by a uniform approach and with a standardized postoperative protocol. Forty-four patients had a minimum 16-month postoperative follow-up. Outcomes were assessed postoperatively by the American Shoulder and Elbow Surgeons (ASES) score and the Penn Shoulder score. Complications were also documented, including need for revision surgery.

RESULTS

The mean age at the time of surgery was 32 years (range, 15-55 years) in the 44 patients. Presenting shoulder complaints included pain alone (40%), instability alone (14%), or pain and instability (45%). Mean number of anchors per repair was 7.9 (range, 5-12). Mean follow-up was 42 months (range, 16-78 months). Mean ± standard deviation ASES score at final follow-up was 90.1 ± 17.7 (range, 22-100), and mean Penn Shoulder score was 90.2 ± 15.3 (range, 38-100). Three of the 4 patients with outcome scores of 70 or less at final follow-up had undergone prior surgery. Thirteen postoperative complications (30%) occurred, with 3 (7%) requiring a second surgery. Five patients (11%) had an instability event following panlabral repair, but only 1 of these patients (2%) required revision surgery for a recurrent labral tear.

CONCLUSION

Combined tears of the anterior, posterior, and superior glenoid labrum represent a small but significant portion of labral injuries. Arthroscopic repair of these injuries can be performed with good postoperative outcomes and a low rate of recurrent labral injury.

摘要

背景

盂唇前、后、上联合撕裂的复合性损伤在文献中鲜有报道。

目的

使用经过验证的评分工具、评估并发症的存在和需要再次手术的情况,评估盂唇前、后、上联合撕裂的关节镜修复的临床效果。

研究设计

病例系列;证据水平,4 级。

方法

通过回顾性研究,在我们医院确定了 58 例盂唇前、后、上联合撕裂的关节镜下修补术患者(定义为全盂唇修补术)。所有患者均采用统一的入路和标准化的术后方案进行关节镜下盂唇修补术和缝合锚钉固定。44 例患者获得了至少 16 个月的术后随访。术后通过美国肩肘外科医师协会(ASES)评分和宾夕法尼亚肩评分评估结果。同时记录并发症,包括需要再次手术的情况。

结果

44 例患者的平均年龄为 32 岁(15-55 岁)。肩部主要表现为疼痛(40%)、单纯不稳(14%)或疼痛伴不稳(45%)。平均每个修复部位使用的锚钉数量为 7.9 个(5-12 个)。平均随访时间为 42 个月(16-78 个月)。末次随访时平均 ASES 评分为 90.1 ± 17.7(22-100),平均 Penn 评分 90.2 ± 15.3(38-100)。在最终随访时评分<70 的 4 例患者中,有 3 例曾接受过手术。术后共发生 13 例并发症(30%),其中 3 例(7%)需要再次手术。全盂唇修补术后有 5 例(11%)发生了不稳定事件,但仅有 1 例(2%)因复发性盂唇撕裂而再次手术。

结论

盂唇前、后、上联合撕裂是盂唇损伤的一小部分,但具有重要意义。这些损伤的关节镜修复可获得良好的术后效果,且再发盂唇损伤的发生率较低。

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