改良Latarjet术治疗伴有骨质缺失的复发性肩关节前脱位的临床疗效分析

发布时间：2018-05-21 01:09

本文选题：改良Latarjet术 + 骨质缺失　；参考：《宁夏医科大学》2015年硕士论文

【摘要】：目的:探讨改良Latarjet术治疗伴有骨质缺失的复发性肩关节前脱位的临床疗效。方法:选取宁夏医科大学总医院创伤骨科2011年2月至2013年9月间就诊的伴有骨质缺失的复发性肩关节前脱位患者25例为研究对象,通过纳入及排除标准排除5例,共有20例伴有骨质缺失的复发性肩关节前脱位患者符合纳入标准,对20例伴有骨质缺失的复发性肩关节前脱位的患者采用肩关节Constant-Murley功能评分及Bigliani肩关节不稳手术修复后稳定性评分以及通过计算喙突移植骨块的骨性愈合率进行疗效评估。结果:纳入研究的20例病人中,有1例失访,19例获得完整随访,随访1到1.5年的时间,(平均15.05个月)。分别在术后1、3、6、12个月对患者进行随访,随访内容包括肩关节X片、CT、肩关节功能恢复情况及Constant-Murley、Bigliani肩关节功能评分。患侧肩关节Constant-Murley功能评分从术前70.15±2.85分提高到术后92.5±1.73,Bigliani肩关节不稳手术修复后稳定性评分从术前3.10±1.71分提高到术后7.15±0.67,喙突移植骨块的骨性愈合率为89.4%。随访患者术后肩关节稳定,无肩关节再脱位的发生,肩关节恐惧实验阴性,术前、术后比较,差异有统计学意义(P0.05)。结论:改良Latarjet术通过恢复导致复发性肩关节前脱位的静力性结构和动力性结构,彻底杜绝了过去各种手术方法术后容易再次复发的问题。能明显改善肩关节的前方稳定性,患者的内旋、外旋及前屈上举等功能明显改善,尤其是相对于传统的Latarjet术极大的减少了肩关节外旋功能的丢失。是临床治疗伴有骨质缺失的复发性肩关节前脱位的有效手术方法,对临床治疗该类疾病具有指导意义。
[Abstract]:Objective: to investigate the clinical effect of modified Latarjet in the treatment of recurrent anterior dislocation of shoulder with bone loss. Methods: from February 2011 to September 2013, 25 patients with recurrent anterior dislocation of shoulder joint with bone loss were selected from Department of Orthopedics, General Hospital of Ningxia Medical University, and 5 cases were excluded by inclusion and exclusion criteria. A total of 20 patients with recurrent anterior dislocation of the shoulder with bone loss met the inclusion criteria. Twenty patients with recurrent anterior dislocation of shoulder with bone loss were evaluated with Constant-Murley function score of shoulder joint, stability score of Bigliani shoulder joint instability after operation and bone healing rate of coracoid process graft bone graft. Results: of the 20 patients in the study, 1 case had lost his visit and 19 cases had been followed up for 1 to 1.5 years (mean 15.05 months). The patients were followed-up at 1: 3 and 12 months, respectively. The follow-up included X ray of shoulder, recovery of shoulder function and Constant-Murley Bigliani shoulder function score. The Constant-Murley score of affected shoulder joint increased from 70.15 卤2.85 before operation to 92.5 卤1.73 after operation on the shoulder joint instability. The stability score increased from 3.10 卤1.71 before operation to 7.15 卤0.67 after operation. The bone healing rate of coracoid bone graft was 89.4. The postoperative shoulder joint stability, no shoulder redislocation, shoulder fear test negative, preoperative and postoperative comparison, the difference was statistically significant (P 0.05). Conclusion: by restoring the static and dynamic structures of recurrent anterior dislocation of shoulder joint, the modified Latarjet procedure has completely eliminated the problem of recurrence easily after operation in the past. It can obviously improve the anterior stability of shoulder joint, and improve the function of internal rotation, external rotation and forward flexion, especially compared with the traditional Latarjet procedure, which greatly reduces the loss of shoulder pronation function. It is an effective surgical method for the treatment of recurrent anterior dislocation of shoulder with bone loss.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

【参考文献】