Objective: To summarize mid-term effectiveness of modified arthroscopic suture button fixation Latarjet procedure for treatment of recurrent anterior shoulder dislocations.
Methods: Between January 2018 and October 2020, 30 patients with recurrent anterior shoulder dislocations were treated with modified arthroscopic suture button fixation Latarjet procedure. There were 19 males and 11 females with an average age of 27.3 years (range, 18-41 years). The shoulder dislocation occurred 3-7 times, with an average of 4.9 times. The time from the last dislocation to operation was 3-10 days, with an average of 4.1 days. Glenoid defects exceeded 20% in all cases. There were 27 cases of Hill-Sachs lesions. The joint pain and function were estimated by visual analogue scale (VAS) score, University of California, Los Angeles (UCLA) score, Rowe score, American Association for Shoulder and Elbow Surgery (ASES) score, Walch-Duplay score, and the range of external rotation at 0° and external rotation at 90° abduction of shoulder before operation and at 1 month, 6 months, and last follow-up. The X-ray film, CT scan and three-dimensional reconstruction were reviewed to observe the position, healing, and absorption of the coracoid graft, correction of glenoid defect, and joint degeneration.
Results: The operation time ranged from 51 to 79 minutes, with an average of 68.4 minutes. All incisions healed without complications such as nerve or blood vessel injury. All patients were followed up 36-60 months with an average of 44.6 months. The VAS score, UCLA score, Rowe score, ASES score, Walch-Duplay score, and the range of external rotation at 0° and external rotation at 90° abduction after operation significantly improved when compared with preoperative values ( P<0.05). All indicators further improved with time, and the differences between different time points after operation were significant ( P<0.05). Imaging review showed that the coracoid graft was located in the anteroinferior glenoid at 1 day after operation, and no occurrence of shoulder osteoarthritis was found during follow-up. The anatomical structure of the glenoid was normal, and no delayed healing or non-union of the coracoid graft occurred. At 20 months after operation, arthroscopic re-exploration was performed in 1 case due to fracutre caused by falling injury revealed the good shaping of the coracoid graft, smooth glenoid, and no bone resorption or osteoarthritis.
Conclusion: For recurrent anterior shoulder dislocations, the modified arthroscopic suture button fixation Latarjet procedure can obtain good recovery of shoulder function and low incidence of complications and has a good mid-term effectiveness.
目的: 总结改良关节镜下弹性固定Latarjet手术治疗复发性肩关节前脱位的中期疗效。.
方法: 2018年1月—2020年10月，采用改良关节镜下弹性固定Latarjet手术治疗30例复发性肩关节前脱位患者。男19例，女11例；年龄18～41岁，平均27.3岁。肩关节脱位3～7次，平均4.9次；肩关节末次脱位至手术时间3～10 d，平均4.1 d。肩胛盂骨缺损均超过20%。合并Hill-Sachs损伤27例。术前、术后1个月、6个月和末次随访时，采用疼痛视觉模拟评分（VAS）、美国加州大学洛杉矶分校（UCLA）评分、Rowe评分、美国肩肘外科协会（ASES）评分、Walch-Duplay评分及0° 外旋、外展90° 外旋活动度评价肩关节疼痛及功能。复查肩关节X线片、CT扫描及三维重建，观察喙突骨块在位、愈合吸收及肩胛盂缺损纠正、肩关节退行性改变程度等情况。.
结果: 手术时间51～79 min，平均68.4 min。术后切口均Ⅰ期愈合，无神经、血管损伤等并发症发生。患者均获随访，随访时间36～60个月，平均44.6个月。术后VAS评分、UCLA评分、Rowe评分、ASES评分、Walch-Duplay评分以及0° 外旋、外展90° 外旋活动度均较术前改善（ P<0.05）；术后随时间延长各指标进一步改善，各时间点间差异均有统计学意义（ P<0.05）。影像学复查示，术后1 d喙突骨块位于肩胛盂前下方；随访期间无肩关节骨关节炎发生，肩胛盂解剖结构正常，无喙突骨块延迟愈合或不愈合。1例因摔伤后骨折，于术后20个月关节镜下二次探查见喙突骨块塑形良好，肩胛盂平整，无骨块吸收及骨关节炎发生。.
结论: 改良关节镜下弹性固定Latarjet手术治疗复发性肩关节前脱位，肩关节功能恢复较好，并发症发生率较低，可获得较好中期疗效。.
Keywords: Modified suture button fixation Latarjet procedure; arthroscopy; mid-term effectiveness; recurrent anterior shoulder dislocation.