关节镜下改良双滑轮技术交叉缝合固定骨性Bankart损伤

doi:10.3877/cma.j.issn.1674-134X.2021.05.013

目的

探讨一种改良双滑轮(double-pulley)交叉缝合技术固定新鲜的骨性Bankart损伤在临床上的使用价值及手术效果。

方法

回顾2018年1月至2020年10月联勤保障部队第九二〇医院运动医学科20例新鲜骨性Bankart损伤，关节镜下使用一种改良double-pulley技术进行缝合、复位、固定骨折块。采用配对样本t检验比较患侧术前、术后及双侧肩关节活动度、美国肩肘外科评分、Constant-Murley肩关节功能评分、Rowe评分和西安大略肩关节不稳指数。

结果

20例新鲜骨性Bankart损伤患者术后骨块复位良好，平均随访时间(15.0±2.8)个月。与术前相比，术后患者主观功能评分有显著的提高、疼痛明显好转(t＝9.903、2.609、27.107、59.173，均为P<0.05)。术后随访未发现骨折块移位，也无感染、血管神经损伤等其他并发症。

结论

关节镜下治疗新鲜的骨性Bankart损伤效果良好，使用改良的double-pulley技术在关节镜下交叉缝合固定新鲜的骨性Bankart损伤，复位效果满意。

关键词: 肩关节, 关节镜, Bankart损伤

Objective

To explore the clinical value and surgical effect of a modified double-pulley technology to fix fresh bony Bankart with cross suture under arthroscopy.

Methods

From January 2018, the Department of Sports Medicine of the 920th Hospital of the Joint Logistics Support Force has performed arthroscopic treatment on 20 patients diagnosed with bony Bankart lesion, and used an modified double-pulley technology for suture, reduction, and fixation. The range of motion of shoulder joint, American shoulder and elbow surgery score (ASES), Constant-Murley scores, Rowe scores and the Western Ontario shoulder instability index (WOSI) were compared with paired sample t test.

Results

From January 2018 to October 2020, 20 patients diagnosed with fresh bony Bankart injury were successfully completed. The postoperative X-ray and CT results showed that 20 patients had good bone mass reduction. The average follow-up time of 20 patients was (15.0±2.8)months. Compared with preoperative data, the subjective function scores were significantly improved, and the pain was relieved (t=9.903, 2.609, 27.107 and 59.173, all P<0.05). No fracture displacement was found in the postoperative follow-up, and no other complication such as infection or vascular nerve injury was found.

Conclusions

Arthroscopic treatment is effective for fresh bony Bankart injuries. The use of modified double-pulley technology to fix fresh bony Bankart lesion with cross suture under arthroscope can achieve anatomical reduction, and the reduction effect is also satisfactory.

Key words: Shoulder, Arthroscope, Bankart lesions

图1 关节盂骨折块面积比计算方法示意图

图6 改良Double-Pulley技术固定骨性Bankart损伤，术中关节镜下示关节盂骨折块呈交叉缝合固定、复位良好

表1 术前与末次随访肩关节活动度比较[°，(±s)]

时间	前屈上举	外展	体侧外旋
术前	175.1±3.0	176.8±2.7	54.5±2.3
末次随访	178.5±1.9	178.2±2.6	50.1±1.4
t值	-7.212	3.048	-2.046
P值	<0.001	0.007	0.055

表1 术前与末次随访肩关节活动度比较[°，(±s)]

时间	前屈上举	外展	体侧外旋
术前	175.1±3.0	176.8±2.7	54.5±2.3
末次随访	178.5±1.9	178.2±2.6	50.1±1.4
t值	-7.212	3.048	-2.046
P值	<0.001	0.007	0.055

表2 术前与末次随访肩关节各项评分比较(±s)

时间	ASES(分)	Constant-Murley评分(分)	Rowe评分(分)	WOSI(%)
术前	83.2±4.4	90.4±5.1	40.1±7.4	33.8±2.8
末次随访	93.9±3.0	93.8±1.7	88.7±3.1	85.6±3.1
t值	9.903	2.609	27.107	59.173
P值	<0.001	0.017	<0.001	<0.001

表2 术前与末次随访肩关节各项评分比较(±s)

时间	ASES(分)	Constant-Murley评分(分)	Rowe评分(分)	WOSI(%)
术前	83.2±4.4	90.4±5.1	40.1±7.4	33.8±2.8
末次随访	93.9±3.0	93.8±1.7	88.7±3.1	85.6±3.1
t值	9.903	2.609	27.107	59.173
P值	<0.001	0.017	<0.001	<0.001

图10 术后第2天，肩关节三维CT平扫重建图，示骨折块复位良好，骨折面平整，关节盂的完整性基本恢复

[1]	Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion[J]. Arthroscopy, 2000, 16(7): 677-694.
[2]	Huysmans PE, Haen PS, Kidd M, et al. The shape of the inferior part of the glenoid: a cadaveric study[J]. J Shoulder Elbow Surg, 2006, 15(6): 759-763.
[3]	Arrigoni P, Brady PC, Burkhart SS. The double-pulley technique for double-row rotator cuff repair[J]. Arthroscopy, 2007, 23(6): 675.e671-674.
[4]	Koo SS, Burkhart SS, Ochoa E. Arthroscopic double-pulley remplissage technique for engaging Hill-Sachs lesions in anterior shoulder instability repairs[J]. Arthroscopy, 2009, 25(11): 1343-1348.
[5]	Nicolas B, Philipe C, Marine A, et al. Contribution of arthroscopy in the treatment of anterior glenoid rim fractures: a comparison with open surgery[J]. J Shoulder Elbow Surg, 2019, 28(1): 42-47.
[6]	Jiang CY, Zhu YM, Liu X, et al. Do reduction and healing of the bony fragment really matter in arthroscopic bony Bankart reconstruction? A prospective study with clinical and computed tomography evaluations[J]. Am J Sports Med, 2013, 41(11): 2617-2623.
[7]	Nakagawa S, Ozaki R, Take Y, et al. Bone fragment union and remodeling after arthroscopic bony bankart repair for traumatic anterior shoulder instability with a glenoid defect: influence on postoperative recurrence of instability[J]. Am J Sports Med, 2015, 43(6): 1438-1447.
[8]	Plath JE, Feucht MJ, Bangoj R, et al. Arthroscopic suture anchor fixation of bony Bankart lesions: clinical outcome, magnetic resonance imaging results, and return to sports[J]. Arthroscopy, 2015, 31(8): 1472-1481.
[9]	Scheibel M, Hug K, Gerhardt C, et al. Arthroscopic reduction and fixation of large solitary and multifragmented anterior glenoid rim fractures[J]. J Shoulder Elbow Surg, 2016, 25(5): 781-790.
[10]	Spiegl UJ, Smith SD, Todd JN, et al. Biomechanical comparison of arthroscopic single- and double-row repair techniques for acute bony Bankart lesions[J]. Am J Sports Med, 2014, 42(8): 1939-1946.
[11]	Lansdown DA, Cvetanovich GL, Zhang AL, et al. Risk factors for intra-articular bone and cartilage lesions in patients undergoing surgical treatment for posterior instability[J]. Am J Sports Med, 2020, 48(5): 1207-1212.
[12]	Etoh T, Yamamoto N, Shinagawa K, et al. Mechanism and patterns of bone loss in patients with anterior shoulder dislocation[J]. J Shoulder Elbow Surg, 2020, 29(10):1974-1980.
[13]	He Y, Peng X, Yuan Z, et al. Modified arthroscopic remplissage for Hill-Sachs lesions with high-strength sutures[J]. Orthopade, 2020, 49(3): 260-266.
[14]	Nakagawa S, Mae T, Yoneda K, et al. Influence of glenoid defect size and bone fragment size on the clinical outcome after arthroscopic Bankart repair in male collision/contact athletes[J]. Am J Sports Med, 2017, 45(9): 1967-1974.
[15]	Zhang J, Jiang C. A new " double-pulley" dual-row technique for arthroscopic fixation of bony Bankart lesion[J]. Knee Surg Sports Traumatol Arthrosc, 2011, 19(9): 1558-1562.

[1]	夏传龙, 迟健, 丛强, 连杰, 崔峻, 陈彦玲. 富血小板血浆联合关节镜治疗半月板损伤的临床疗效[J]. 中华关节外科杂志(电子版), 2023, 17(06): 877-881.
[2]	欧阳剑锋, 李炳权, 叶永恒, 胡少宇, 向阳. 关节镜联合富血小板血浆治疗粘连性肩周炎的疗效[J]. 中华关节外科杂志(电子版), 2023, 17(06): 765-772.
[3]	肖志满, 龚煜, 谢景凌, 刘斌伟. 上下肢关节镜手术后患者下肢深静脉血栓发生的对比研究[J]. 中华关节外科杂志(电子版), 2023, 17(05): 601-606.
[4]	杨国栋, 张辉, 郭珈, 曲迪, 张静, 戚超. 外侧半月板后角撕裂是否修复的术后疗效对比[J]. 中华关节外科杂志(电子版), 2023, 17(05): 619-624.
[5]	马鹏程, 刘伟, 张思平. 股骨髋臼撞击综合征关节镜手术中闭合关节囊的疗效影响[J]. 中华关节外科杂志(电子版), 2023, 17(05): 653-662.
[6]	陈宏兴, 张立军, 张勇, 李虎, 周驰, 凡一诺. 膝骨关节炎关节镜清理术后中药外用疗效的Meta分析[J]. 中华关节外科杂志(电子版), 2023, 17(05): 663-672.
[7]	邢阳, 何爱珊, 康焱, 杨子波, 孟繁钢, 邬培慧. 前交叉韧带单束联合前外侧结构重建的Meta分析[J]. 中华关节外科杂志(电子版), 2023, 17(04): 508-519.
[8]	吴俊贤, 曾俊杰, 许有银, 苑博. 体外冲击波疗法辅助治疗肩袖修补术后关节僵硬[J]. 中华关节外科杂志(电子版), 2023, 17(04): 571-576.
[9]	齐伟亚, 方杰, 吴衡, 刘波. 掌侧小切口联合腕关节镜治疗AO－C型桡骨远端骨折[J]. 中华关节外科杂志(电子版), 2023, 17(04): 577-582.
[10]	邬春虎, 马玉海, 陈长松, 尹华东, 朱晓峰, 何剑星, 刘彧. 冲击波联合富血小板血浆对骨关节炎软骨损伤的疗效[J]. 中华关节外科杂志(电子版), 2023, 17(03): 334-339.
[11]	杨大威, 张鑫. 肩关节上方悬吊复合体损伤研究进展[J]. 中华肩肘外科电子杂志, 2023, 11(03): 193-197.
[12]	龙珂, 戴祝, 刘全辉. 关节镜下肩袖修补联合喙突成形治疗肩袖撕裂合并喙突下囊肿[J]. 中华肩肘外科电子杂志, 2023, 11(03): 198-203.
[13]	郑翰, 丁国强, 谢鹏, 卢冰. 切开Latarjet手术治疗复发性肩关节前脱位的随访研究[J]. 中华肩肘外科电子杂志, 2023, 11(03): 204-211.
[14]	黄瑶, 袁滨, 束昊, 王磊, 孙鲁宁. 关节镜下带线锚钉修补术治疗Ⅴ型SLAP损伤临床观察[J]. 中华肩肘外科电子杂志, 2023, 11(03): 218-223.
[15]	张镇斌, 闫兆龙, 王功腾, 张文琦, 王旭凤, 李广兴, 孙华强, 李树锋. 关节镜对胫骨高位截骨术治疗膝骨关节炎的效果研究[J]. 中华老年骨科与康复电子杂志, 2023, 09(04): 218-225.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Modified double-pulley technology to fix bony Bankart injury with cross suture by arthroscope

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Modified double-pulley technology to fix bony Bankart injury with cross suture by arthroscope