Arthroscopic glenoid labrum repair and combined joint capsule and partial subscapularis suture for recurrent anterior shoulder dislocation

doi:10.3969/j.issn.2095-4344.2015.11.019

Abstract

Abstract:

BACKGROUND: Arthroscopic glenoid labrum repair is the main therapy for recurrent anterior shoulder dislocation, which cannot meet the demands of shoulder stability. How to strengthen the anterior shoulder stability is an issue that is always explored and pursued.

OBJECTIVE: To explore the effectiveness of arthroscopic glenoid labrum repair and combined joint capsule and partial subscapularis suture for recurrent anterior shoulder dislocation.

METHODS: Seventy patients admitted for recurrent anterior shoulder dislocation at the Department of Orthopedics, First Affiliated Hospital of Anhui Medical University in China from October 2010 to August 2013 were enrolled, who received the arthroscopic glenoid labrum repair and combined joint capsule and partial subscapularis suture. Patients undergoing post-operative systematical rehabilitation were followed up for Constant-Murley Score and the ROWE Score for Instability, and shoulder stability and motor functions were evaluated in patients.

RESULTS AND CONCLUSION: The 70 patients were followed-up for 11-46 months. Complications only appeared in one patient with acute pulmonary edema and five patients with elbow or forearm skin blisters, but all were cured by treatment. Anterior shoulder dislocation disappeared postoperatively in all patients. Sixty-five

patients almost recovered in the range of motion of the shoulder, who were satisfied with normal life and work activity. All the patients returned to work. At the last follow-up, the Constant-Murley score was improved from 71.2±5.3 to 94.3±4.9, and the ROWE score was increased from 32.1±4.2 to 95.1±4.7, both of which were better than before (P < 0.05). This study demonstrated arthroscopic glenoid labrum repair and combined joint capsule and partial subscapularis suture is better for recurrent anterior shoulder dislocation, which is conductive to shoulder stability and motor function recovery.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

全文链接：

Key words: Shoulder Dislocation, Arthroscopes, Follow-Up Studies

CLC Number:

R318

Xu Bin, Tu Jun. Arthroscopic glenoid labrum repair and combined joint capsule and partial subscapularis suture for recurrent anterior shoulder dislocation[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(11): 1739-1744.

Figures/Tables 2

2.1 参与者数量分析按意向性处理，纳入70例复发性肩关节脱位患者，修复术后均完成随访，未出现失访现象。 2.2 随访结果 70例患者经过11-46个月的随访，治疗后肩关节稳定性均恢复，未再发生脱位。末次随访肩关节ROWE评分上升到(95.1±4.7)分，其中稳定性项目评分所有患者均为50分；Constant-Murley肩关节评分上升到(94.3±4.9)分，两项评分均较治疗前明显增高(P < 0.05，见表1)。70例患者中65例患者肩关节活动度恢复基本正常，5例患者肩关节活动度轻度受限，以外展、外旋为主，但活动度在正常活动度的50%以上，能够满足日常生活及工作的活动需要。所有患者均未遗留明显的肩关节疼痛症状，均能正常工作和生活。 2.3 典型病例男性患者，42岁，因“外伤致右肩关节脱位7年反复发作十余次”来本科就诊，诊断“右肩关节复发性脱位，右肩关节Hill-sachs损伤，右肩前下盂唇损伤”。在本科术前评估中明确该患者存在肱骨头软骨缺损但未达20%，肩关节前下盂唇损伤，但未达25%，符合研究标准(图2A，B)。治疗前对患者一般情况、Constant-Murley肩关节评分、肩关节ROWE评分进行详细记录。修复术中将患者前下盂唇彻底松解并与部分肩胛下肌腱、关节囊一起缝合固定于前下盂唇(图2C)。修复术后常规康复方案指导康复锻炼。共随访12个月，肩关节Constant-Murley肩关节评分由治疗前的70分上升到92分，ROWE评分由治疗前25分上升到95分，肩关节未再发生脱位，关节活动度基本正常，能够完成日常工作和生活中所需要的肩关节活动，无显著疼痛，患者回到原工作岗位。 2.4 不良事件 1例63岁女性患者在修复手术结束后出现急性肺水肿，经呼吸机辅助呼吸、消肿对症治疗后迅速康复，治疗后第2天症状完全消失，第3天患者下地活动，第7天顺利出院。有5例患者在修复术后出现肘部或前臂皮肤水泡，在反复仔细查找原因后认定是在手术过程中等离子消融刀的引流管引出的高温灌注液滴落至皮肤导致热灼伤所致，后经改进未再发生类似并发症。所有患者灼伤处皮肤经积极治疗后迅速康复。无其他明显不良事件出现。 "

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