1、感染、炎症、修复 2022 年 12 月第 23 卷 第 4 期.213.关节镜 Bankart 损伤修复术结合 Remplissage 术与单独开放性 Bankart修复术治疗复发性肩关节前脱位的效果比较何 骁 邓莉莉（郴州市第一人民医院，湖南 郴州 423000）【摘要】目的：评价分别应用关节镜 Bankart 手术+Remplissage 术与开放性 Bankart 修复术治疗 Bankart损伤合并 Hill-Sachs 损伤的复发性肩关节前脱位的疗效。方法：86 例 Bankart 损伤合并 Hill-Sachs 损伤的复发性肩关节前脱位患者纳入本研究，随机分为联合手术组及开放手术组
2、。开放手术组（n=43 例）行开放性 Bankart 修复术治疗，联合手术组（n=43 例）行关节镜下 Bankart 手术并 Remplissage 手术治疗。观察两组患者的手术指标，用肩关节功能评分量表（Rowe 评分）评估肩功能恢复程度，用视觉模拟评分（VAS）法评估两组患者的疼痛程度，比较并发症发生率。结果：联合手术组患者的手术切口（3.910.67）cm 显著低于开放手术组（14.651.29）cm，术中出血量（11.402.74）mL 显著低于开放手术组（45.6915.39）mL，手术时间（38.6611.26）min显著短于开放手术组（85.6718.72）min，住院时间（9
3、.851.37）d 显著短于开放手术组（16.353.87）d，P 0.01。术前，两组患者的 VAS 疼痛评分和 Rowe 评分组间比较差异无统计学意义（P 0.05）；术后，联合手术组患者的 VAS 评分（1.040.96）分 显著低于开放手术组（2.641.41）分，P 0.001，Rowe 评分（71.887.41）分 显著高于开放手术组（51.927.62）分，P 0.001。联合手术组患者并发症总发生率（2.33%）明显低于开放手术组（20.93%，P 0.01）；优良率（97.67%）明显高于开放手术组（76.74%，P 0.05）。结论：与开放性 Bankart 手术相比，Ba
4、nkart 损伤合并 Hill-Sachs 损伤的复发性肩关节前脱位患者应用关节镜Bankart+Remplissage 术治疗后，患者机体受到的创伤较小，恢复时间更短，疼痛程度更轻，肩关节功能恢复更好，且并发症少，临床安全性高，疗效确切。关键词：关节镜 Bankart 损伤 Remplissage Hill-Sachs 损伤 肩关节前脱位，复发性中图分类号：R687.4；R687 文献标识码：AComparison on the effect of Bankart arthroscopic repair combined with Remplissage and open Bankart a
5、lone in the treatment of recurrent anterior dislocation of shoulder jointHe Xiao,Deng Lili.The First Peoples Hospital of Chenzhou,Chenzhou,Hunan 423000,ChinaAbstract Objective:To evaluate the efficacy of Bankart arthroscopic surgery+Remplissage and open Bankart repair for Bankart injury combined wit
6、h Hill-Sachs recurrent anterior dislocation of shoulder joint.Methods:Eighty-six patients with Bankart injury combined with Hill-Sachs recurrent anterior dislocation of shoulder joint were selected and included in this study.They were randomly divided into combined operation group and open operation
7、 group.The open operation group(n=43)underwent open Bankart repair,and the combined operation group(n=43)underwent arthroscopic Bankart operation and reimplissage surgery.The surgical indexes of the two groups were observed,and the shoulder function recovery degree was assessed by the shoulder Joint
8、 function scale(Rowe score),the pain degree was evaluated by visual analog scale(VSA),and the incidence of complications was compared.Results:The surgical incision(3.910.67)cm in the combined operation group was significantly lower than that in the open operation group(14.651.29)cm.The intraoperativ
9、e blood loss(11.402.74)mL was significantly lower than that in the open operation group(45.6915.39)mL.The operation time(38.6611.26)min was significantly shorter than that in the open operation group(85.6718.72)min.And the hospital stay(9.851.37)d was significantly shorter than that in the open oper
10、ation group(16.353.87)d,P0.05).After surgery,the VAS score(1.040.96)points of the combined operation group was significantly lower than that in the open operation group(2.641.41)points,P0.001.The Rowe score(71.887.41)points was also significantly lower than in the open operation group(51.927.62)DOI:
11、10.3969/j.issn.1672-8521.2022.04.006论 著基金项目：湖南省郴州市运动医学技术研发中心项目资助郴科发（2021）57号Infect Inflamm Rep,Vol.23,No.4,Dec.2022.214.points,P0.001.The overall incidence of complications in the combined operation group(2.33%)was significantly lower than that in the open operation group(20.93%,P0.01),and the excel
12、lent rate(97.67%)was significantly higher than that in the open operation group(76.74%,P0.05).Conclusions:Compared with open Bankart surgery,patients with recurrent anterior dislocation caused by Bankart injury combined with Hill-Sachs injury undergo arthroscopic Bankart+Remplissage,which resulted i
13、n less physical trauma,shorter recovery time,less pain,and better shoulder function recovery.Moreover,it has less complications,high clinical safety and accurate efficacy.Keywords:Arthroscopic;Brankart injury;Remplissage;Hill-Sachs injury;Recurrent anterior dislocation of joint肩关节前脱位由外力撞击所致，其发生率为2%1
14、，患者可能在合并 Bankart 损伤同时伴有Hill-Sachs 损伤；如果手术治疗中仅注重软组织修复，对骨性结构的处理不太重视，术后就容易复发脱位2，使患者日常生活活动受限。在年轻患者中复发性脱位发生率较高，并普遍发生于青壮年男性。本病的主要治疗方案是手术3。传统开放性 Bankart 损伤修复术是经典术式之一，但会对机体造成较大的创伤，术后易产生多种并发症，患者后续康复速度较慢4，预后效果不理想。在关节镜技术发展的背景下，关节镜 Bankart 损伤修复术在临床上应用广泛，用于复发性肩关节脱位的治疗可减轻患者术后疼痛，并获得理想的治疗效果3。但也有研究认为，该术与开放性手术疗效相当5。复
15、发性肩关节脱位，尤其是创伤性肩关节前方不稳的患者，应用关节镜 Remplissage 手术可取得理想的效果6。本研究中，我们选取了同时存在 Bankart 损伤和 Hill-Sachs 损伤的复发性肩关节前脱位患者，采用关节镜下 Bankart 损伤修复术并配合 Remplissage 术治疗，与行开放性Bankart 术式治疗患者进行了疗效比较。1 资料与方法1.1 临床资料 采用前瞻性研究方法，将郴州市第一人民医院 2019 年 12 月2022 年 6 月收治的复发性肩关节前脱位患者 86 例纳入本研究。病例纳入标准：肩关节前脱位的诊断符合文献 7 中相关标准；非陈旧性脱位；临床资料完整
16、；具有较高的依从性；经磁共振等影像学检查确诊伴有 Bankart 损伤与 Hill-Sachs 损伤。排除合并有精神疾病、骨折、神经血管损伤、骨质疏松、脱位前有功能异常的患者。入选患者按照随机数字表法分为联合手术组与开放手术组。联合手术组患者 43 例，男 23 例，女 20 例；年龄 22 51 岁，平均（31.715.31）岁；病程 3 31 个月，平均（20.715.85）个月。开放手术组患者 43 例，男22 例，女 21 例；年龄 21 52 岁，平均（31.58 5.21）岁；病程 5 31 个月，平均（20.585.69）月。两组一般资料比较差异无统计学意义（P 0.05）。本研究取得了患者和家属同意，签署了知情同意书，并在我院伦理委员会审批后开展。1.2 治疗方法1.2.1 开放手术组 患者全身麻醉（全麻），健侧卧位，肩关节前外侧入路，充分保留损伤的关节囊，检查肩盂、关节囊-韧带盂唇复合体等组织，肩盂周围如有增生组织则需清除，充分暴露新鲜鼓面，在 6、8、10 点钟位置和 2、7、4 点钟位置置入锚钉，缝合肩胛下肌关节囊。1.2.2 联合手术组 患者采用关节镜下 Ban