An Baijing, Wang Yaoting, Wang Mingxin, Zhang Haochong, Xing Gengyan
Department of Sports Medicine, Senior Department of Orthopedics, the Fourth Medical Centre of Chinese PLA General Hospital, Beijing, 100048, P. R. China.
Department of Joint Surgery, Senior Department of Orthopedics, the Fourth Medical Centre of Chinese PLA General Hospital, Beijing, 100048, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022 Feb 15;36(2):143-148. doi: 10.7507/1002-1892.202109044.
To evaluate the effectiveness of arthroscopic Pushlock anchor fixation with iliac creast bone autograft in the treatment of recurrent anterior shoulder instability with critical bone defect.
The clinical data of 80 patients with recurrent anterior shoulder instability with critical bone defect treated by arthroscopic Pushlock anchor fixation with iliac creast bone autograft between January 2016 and January 2019 were retrospectively analyzed. The patients were all male; they were 18-45 years old at the surgery, with an average of 25 years old. The disease duration ranged from 3 months to 5 years, with an average of 2 years. The shoulder joint dislocated 3-50 times, with an average of 8 times. X-ray films, MRI, CT scans and three-dimensional reconstruction of the shoulder were performed before operation. The area of the anterior glenoid defect was 25%-45%, with an average of 27.3%. The shoulder mobility (forward flexion and external rotation in abduction at 90°), the Constant-Murley score, and the Rowe score were used to evaluate the shoulder function before operation and at last follow-up.
Patients were followed up 1-3 years, with an average of 2 years. No shoulder dislocation occurred again during follow-up. All partial graft absorption occurred after operation, CT scan showed that the graft absorption ratio was less than 30% at 1 week and 3 months after operation. CT three-dimensional reconstruction at 1 year after operation showed that all grafts had healed to the glenoid. The anterior glenoid bone defect was less than 5% (from 0 to 5%, with an average of 3.2%). At last follow-up, the shoulder mobility (forward flexion and external rotation in abduction at 90°), the Constant-Murley score, and the Rowe score significantly improved when compared with preoperative ones ( <0.05). The shoulder mobility of external rotation in abduction at 90° of the affected side limited when compared with the healthy side [(6.7±5.1)°].
Arthroscopic Pushlock anchor fixation with iliac creast bone autograft has a good effectiveness in the treatment of recurrent anterior shoulder instability with critical bone defect. The method is relatively simple and the learning curve is short.
评估关节镜下使用推锁锚钉固定联合髂嵴自体骨移植治疗伴有严重骨缺损的复发性肩关节前脱位的疗效。
回顾性分析2016年1月至2019年1月期间80例采用关节镜下推锁锚钉固定联合髂嵴自体骨移植治疗的伴有严重骨缺损的复发性肩关节前脱位患者的临床资料。患者均为男性；手术时年龄18 - 45岁，平均25岁。病程3个月至5年，平均2年。肩关节脱位3 - 50次，平均8次。术前均行X线片、MRI、CT扫描及肩关节三维重建。前方关节盂缺损面积为25% - 45%，平均27.3%。采用肩关节活动度（90°外展时前屈和外旋）、Constant - Murley评分及Rowe评分对术前及末次随访时的肩关节功能进行评估。
患者随访1 - 3年，平均2年。随访期间未再次发生肩关节脱位。术后均有部分植骨吸收，CT扫描显示术后1周及3个月时植骨吸收率小于30%。术后1年CT三维重建显示所有植骨均与关节盂愈合。前方关节盂骨缺损小于5%（0至5%，平均3.2%）。末次随访时，与术前相比，肩关节活动度（90°外展时前屈和外旋）、Constant - Murley评分及Rowe评分均显著改善（<0.05）。患侧90°外展时外旋的肩关节活动度与健侧相比受限[（6.7±5.1）°]。
关节镜下推锁锚钉固定联合髂嵴自体骨移植治疗伴有严重骨缺损的复发性肩关节前脱位疗效良好。该方法相对简单，学习曲线短。
