【摘 要】 目的 通過分析肩關節(jié)前脫位次數(shù)、病程與關節(jié)內(nèi)繼發(fā)損傷的關系，探討復發(fā)性肩關節(jié)前脫位對關節(jié)內(nèi)繼發(fā)損傷的影響。 方法 回顧分析2005年1月－2009年6月關節(jié)鏡下應用縫合錨釘行Bankart重建術治療的59例復發(fā)性肩關節(jié)前脫位患者臨床資料。男48例，女11例；年齡15～42歲，平均27.6歲。初次脫位原因：接觸性體育運動21例，非接觸性體育運動13例，日?；顒?1例，外傷14例。術前脫位3～32次，平均10.6次。初次脫位至手術時間為11個月～12年，中位時間5.9年?；颊呖謶衷囼灱皬臀辉囼灳赎栃?。術前美國加州大學洛杉磯分校（UCLA）肩關節(jié)功能評分為（22.3 ± 2.4）分，Constant-Murley評分為（73.1 ± 5.8）分。關節(jié)鏡下觀察關節(jié)內(nèi)繼發(fā)損傷情況，并進行統(tǒng)計分析。 結果 術后患者切口均Ⅰ期愈合?；颊呔@隨訪，隨訪時間16～58個月，平均37.3個月。末次隨訪時，UCLA肩關節(jié)功能評分為（34.6 ± 1.7）分，Constant-Murley評分為（86.7 ± 6.1）分，與術前比較差異均有統(tǒng)計學意義（P lt; 0.05）。術前關節(jié)脫位次數(shù)和關節(jié)軟骨損傷的嚴重程度成正相關（rs=0.345，P=0.007），和Hill-Sachs損傷嚴重程度成正相關（rs=0.708，P=0.000）；首次脫位至手術時間和關節(jié)軟骨損傷嚴重程度成正相關（rs=0.498，P=0.000），與Hill-Sachs損傷嚴重程度無相關性（rs=0.021，P=0.874）。 結論 復發(fā)性肩關節(jié)前脫位早期行Bankart重建有利于肩關節(jié)功能恢復，避免或延緩關節(jié)內(nèi)繼發(fā)損傷的發(fā)生和發(fā)展。
引用本文： 李海峰,劉玉杰,李眾利,李春寶,董曉艷,朱娟麗,劉洋. 復發(fā)性肩關節(jié)前脫位與關節(jié)內(nèi)繼發(fā)損傷的相關性研究. 中國修復重建外科雜志, 2012, 26(3): 308-312. doi: 復制
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| 2. | Deitch J, Mehlman CT, Foad SL, et al. Traumatic anterior shoulder dislocation in adolescents. Am J Sports Med, 2003, 31(5): 758-763. |
| 3. | Yiannakopoulos CK, Mataragas E, Antonogiannakis E. A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Arthroscopy, 2007, 23 (9): 985-990. |
| 4. | Calandra JJ, Baker CL, Uribe J. The incidence of Hill-Sachs lesions in initial anterior shoulder dislocations. Arthroscopy, 1989, 5(4): 254-257. |
| 5. | Cameron ML, Kocher MS, Briggs KK, et al. The prevalence of glenohumeral osteoarthrosis in unstable shoulder. Am J Sports Med, 2003, 31(1): 53-55. |
| 6. | Snyder SJ, Banas MP, Karzel RP, et al. An analysis of 140 injuries to the superior glenoid labrum. J Shoulder Elbow Surg, 1995, 4(4): 243-248. |
| 7. | Brophy RH, Marx RG. The treatment of traumatic anterior instability of the shoulder: nonoperative and surgical treatment. Arthroscopy, 2009, 25(3): 298-304. |
| 8. | Handoll HH, Almaiyah MA, Rangan A. Surgical versus non-surgical treatment for acute anterior shoulder dislocation. Cochrane Database Syst Rev, 2004, (1): CD004325. |
| 9. | 朱獻忠, 黃富國. 盂肱韌帶維持肩關節(jié)前方穩(wěn)定性生物力學研究. 中國修復重建外科雜志, 2007, 21(11): 1175-1178. |
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| 11. | Marx RG, McCarty EC, Montemurno TD, et al. Development of arthrosis following dislocation of the shoulder: a case-control study. J Shoulder Elbow Surg, 2002, 11(1): 1-5. |
| 12. | Cheung EV, Sperling JW, Hattrup SJ, et al. Long-term outcome of anterior stabilization of the shoulder. J Shoulder Elbow Surg, 2008, 17(2): 265-270. |
| 13. | Larrain MV, Montenegro HJ, Mauas DM, et al. Arthroscopic management of traumatic anterior shoulder instability in collision athletes: analysis of 204 cases with a 4- to 9-year follow-up and results with the suture anchor technique. Arthroscopy, 2006, 22(12): 1283-1289. |
| 14. | Kim TK, Queale WS, Cosgarea AJ, et al. Clinical features of the different types of SLAP lesions: an analysis of one hundred and thirty-nine cases. J Bone Joint Surg (Am), 2003, 85-A(1): 66-71. |
| 15. | Porcellini G, Paladini P, Campi F, et al. Shoulder instability and related rotator cuff tears: arthroscopic findings and treatment in patients aged 40 to 60 years. Arthroscopy, 2006, 22 (3): 270-276. |
| 16. | 劉玉杰, 周密, 李光輝, 等. 肩關節(jié)脫位合并肩袖與Bankart損傷的診治. 中華創(chuàng)傷骨科雜志, 2008, 10(10): 915-918. |
| 17. | Law BK, Yung PS, Ho EP, et al. The surgical outcome of immediate arthroscopic Bankart repair for first time anterior shoulder dislocation in young active patients. Knee Surg Sports Traumatol Arthrosc, 2008, 16 (2): 188-193. |
- 1. Hayes K, Callanan M, Walton J, et al. Shoulder instability: management and rehabilitation. J Orthop Sports Phys Ther, 2002, 32(10): 497-509.
- 2. Deitch J, Mehlman CT, Foad SL, et al. Traumatic anterior shoulder dislocation in adolescents. Am J Sports Med, 2003, 31(5): 758-763.
- 3. Yiannakopoulos CK, Mataragas E, Antonogiannakis E. A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Arthroscopy, 2007, 23 (9): 985-990.
- 4. Calandra JJ, Baker CL, Uribe J. The incidence of Hill-Sachs lesions in initial anterior shoulder dislocations. Arthroscopy, 1989, 5(4): 254-257.
- 5. Cameron ML, Kocher MS, Briggs KK, et al. The prevalence of glenohumeral osteoarthrosis in unstable shoulder. Am J Sports Med, 2003, 31(1): 53-55.
- 6. Snyder SJ, Banas MP, Karzel RP, et al. An analysis of 140 injuries to the superior glenoid labrum. J Shoulder Elbow Surg, 1995, 4(4): 243-248.
- 7. Brophy RH, Marx RG. The treatment of traumatic anterior instability of the shoulder: nonoperative and surgical treatment. Arthroscopy, 2009, 25(3): 298-304.
- 8. Handoll HH, Almaiyah MA, Rangan A. Surgical versus non-surgical treatment for acute anterior shoulder dislocation. Cochrane Database Syst Rev, 2004, (1): CD004325.
- 9. 朱獻忠, 黃富國. 盂肱韌帶維持肩關節(jié)前方穩(wěn)定性生物力學研究. 中國修復重建外科雜志, 2007, 21(11): 1175-1178.
- 10. Taylor DC, Arciero RA. Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first-time, traumatic anterior dislocations. Am J Sports Med, 1997, 25(3): 306-311.
- 11. Marx RG, McCarty EC, Montemurno TD, et al. Development of arthrosis following dislocation of the shoulder: a case-control study. J Shoulder Elbow Surg, 2002, 11(1): 1-5.
- 12. Cheung EV, Sperling JW, Hattrup SJ, et al. Long-term outcome of anterior stabilization of the shoulder. J Shoulder Elbow Surg, 2008, 17(2): 265-270.
- 13. Larrain MV, Montenegro HJ, Mauas DM, et al. Arthroscopic management of traumatic anterior shoulder instability in collision athletes: analysis of 204 cases with a 4- to 9-year follow-up and results with the suture anchor technique. Arthroscopy, 2006, 22(12): 1283-1289.
- 14. Kim TK, Queale WS, Cosgarea AJ, et al. Clinical features of the different types of SLAP lesions: an analysis of one hundred and thirty-nine cases. J Bone Joint Surg (Am), 2003, 85-A(1): 66-71.
- 15. Porcellini G, Paladini P, Campi F, et al. Shoulder instability and related rotator cuff tears: arthroscopic findings and treatment in patients aged 40 to 60 years. Arthroscopy, 2006, 22 (3): 270-276.
- 16. 劉玉杰, 周密, 李光輝, 等. 肩關節(jié)脫位合并肩袖與Bankart損傷的診治. 中華創(chuàng)傷骨科雜志, 2008, 10(10): 915-918.
- 17. Law BK, Yung PS, Ho EP, et al. The surgical outcome of immediate arthroscopic Bankart repair for first time anterior shoulder dislocation in young active patients. Knee Surg Sports Traumatol Arthrosc, 2008, 16 (2): 188-193.