Hardy P, Thabit G, Fanton G S, Blin J L, Lortat-Jacob A, Benoit J
Service de Chirurgie Orthopédique, Hôpital Ambroise Paré, C.H.U. Paris Ouest, Boulogne.
Orthopade. 1996 Feb;25(1):91-3.
Current arthroscopic treatments do not address satisfactorily the capsular redundancy frequently associated with the Bankart lesion in recurrent anterior dislocation. Although the Bankart lesion heals, many of the recurrences after arthroscopic procedures are due to capsular redundancy and the laxity of glenohumeral ligaments. We propose that laser-assisted capsular shrinkage (LACS) be combined with arthroscopic labrum reattachment. As shown by Market et al., significant capsular shrinkage can be achieved by the application of non-ablative Ho:YAG laser energy without detrimental effects to the relaxation properties of the tissue. For 1 year we have used LACS together with labrum suture in 18 shoulders in 18 patients (mean age 24.6 years). All patients suffered from chronic anterioinferior recurrent dislocation. The labrum suture was realized by an anterior reattachment (REVO screws, Linvatec, USA) or by transglenoid suture. Two or three sutures were passed through the torn labrum with 2/0 non-absorbable suture material. The LACS procedure was performed with a holmium:YAG laser (VersaPulse, Coherent, USA) at an energy of 10 W (1 J, 10 Hz) with a 30 degrees curved handpiece. All patients were immobilized in a sling for 4 weeks postoperatively. Physical therapy was begun at 1 month with passive and active exercise. To date, none of the patients have had a recurrence. Seven of 18 patients returned to their previous sports activity, and at the same level. None of the patients had an iatrogenic lesion due to the laser application or labrum suture. Compared to the other shoulder, the loss of external rotation with the arm 90 degrees abducted was 30 degrees at 4 weeks and 10 degrees at 4 months. We think that the LACS procedure is a good treatment for the capsular redundancy that is frequently associated with Bankart's lesion in recurrent anterior dislocation and is probably responsible for the high failure rate in current arthroscopic procedures. Our results are short-term results, but we expect the capsular shrinkage associated with the labrum reattachment will provide a long-term success rate that is comparable to open procedures.
目前的关节镜治疗方法不能令人满意地解决复发性前脱位中经常与Bankart损伤相关的关节囊冗余问题。尽管Bankart损伤能够愈合，但关节镜手术后的许多复发是由于关节囊冗余和盂肱韧带松弛所致。我们建议将激光辅助关节囊收缩术（LACS）与关节镜下盂唇重新附着术相结合。正如Market等人所示，应用非消融性钬：钇铝石榴石激光能量可实现显著的关节囊收缩，且不会对组织的松弛特性产生有害影响。一年来，我们对18例患者的18个肩部采用了LACS联合盂唇缝合术（平均年龄24.6岁）。所有患者均患有慢性前下复发性脱位。盂唇缝合通过前侧重新附着（REVO螺钉，美国Linvatec公司）或经关节盂缝合实现。用2-0不可吸收缝合材料将两到三根缝线穿过撕裂的盂唇。LACS手术使用钬：钇铝石榴石激光（美国Coherent公司的VersaPulse），能量为10W（1J，10Hz），使用30度弯曲的手持器械。所有患者术后用吊带固定4周。术后1个月开始物理治疗，包括被动和主动运动。迄今为止，所有患者均未复发。18例患者中有7例恢复到之前的运动水平且运动强度相同。没有患者因激光应用或盂唇缝合出现医源性损伤。与对侧肩部相比，患侧上肢外展90度时的外旋丧失在4周时为30度，在4个月时为10度。我们认为，LACS手术是治疗复发性前脱位中经常与Bankart损伤相关的关节囊冗余的良好方法，这可能是目前关节镜手术失败率高的原因。我们的结果是短期结果，但我们预计与盂唇重新附着相关的关节囊收缩将提供与开放手术相当的长期成功率。
