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改良 Latarjet 术(未修复关节囊和盂唇)治疗运动员复发性肩关节前脱位失败

Modified Latarjet Procedure Without Capsulolabral Repair for the Treatment of Failed Previous Operative Stabilizations in Athletes.

机构信息

Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

出版信息

Arthroscopy. 2018 May;34(5):1421-1427. doi: 10.1016/j.arthro.2017.12.006. Epub 2018 Feb 3.

Abstract

PURPOSE

To analyze time to return to sport, functional outcomes, and recurrences of the modified Latarjet procedure without capsulolabral repair in athletes with recurrent anterior shoulder instability after a failed previous operative stabilization.

METHODS

We included athletes with recurrent anterior shoulder instability with a previous failed operative stabilization treated with the modified Latarjet procedure without capsulolabral repair with a minimum of 2-year follow-up. Return to sports, range of motion, the Rowe score, a visual analog scale for pain in sport activity, and the Athletic Shoulder Outcome Scoring System were used to assess functional outcomes. Recurrences were also evaluated. The postoperative bone block position and consolidation were assessed with computed tomography.

RESULTS

Between June 2008 and June 2015, 68 athletes were treated with the modified Latarjet procedure without capsulolabral reconstruction for recurrent shoulder instability after a previous failed stabilization surgery. The mean follow-up was 44 months (range, 24-108 months), and the mean age at the time of operation was 26.8 years (range, 17-35 years). All the patients returned to sports, and 95% returned to the same sport they practiced before the surgery, all to the same level. No significant difference in shoulder range of motion was found between preoperative and postoperative results. The Rowe score, visual analog scale, and Athletic Shoulder Outcome Scoring System showed statistical improvement after operation (P < .001). There was no recurrence of shoulder dislocation or subluxation. The bone block healed in 92% of patients. There were 8 complications (12.3%) and 2 reoperations (3%).

CONCLUSIONS

In athletes with previous failed operative stabilization procedures, the modified Latarjet without capsulolabral repair produced excellent functional outcomes with most athletes returning to sport at the same level they had before the surgery without recurrences.

LEVEL OF EVIDENCE

Level IV, therapeutic, case series study.

摘要

目的

分析改良 Latarjet 术(不修复盂唇关节囊复合体)治疗初次手术失败的复发性肩关节前向不稳定运动员的重返运动时间、功能结果和复发情况。

方法

我们纳入了有复发性肩关节前向不稳定病史,且先前手术失败的运动员,他们接受了改良 Latarjet 术(不修复盂唇关节囊复合体)治疗,随访时间至少 2 年。采用重返运动时间、关节活动度、Rowe 评分、运动时疼痛的视觉模拟评分、以及 Athletics Shoulder Outcome Scoring System 评估功能结果。还评估了复发情况。术后采用 CT 评估骨块位置和骨愈合情况。

结果

2008 年 6 月至 2015 年 6 月,68 例运动员因初次手术失败后复发性肩关节不稳定接受改良 Latarjet 术(不修复盂唇关节囊复合体)治疗。平均随访时间为 44 个月(范围 24-108 个月),手术时的平均年龄为 26.8 岁(范围 17-35 岁)。所有患者均重返运动,95%的患者重返术前运动水平,且从事的运动项目与术前相同。术前和术后的肩关节活动度无显著差异。Rowe 评分、视觉模拟评分和 Athletics Shoulder Outcome Scoring System 在术后均有统计学改善(P<.001)。无肩关节再脱位或半脱位复发。92%的患者骨块愈合。有 8 例(12.3%)并发症和 2 例(3%)再手术。

结论

在初次手术失败的运动员中,改良 Latarjet 术(不修复盂唇关节囊复合体)可获得良好的功能结果,大多数患者重返术前运动水平,且无复发。

证据等级

IV 级,治疗性病例系列研究。

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