| 金鹏鹏,唐露露,柯友群,等.经腋窝入路开放手术与关节镜下微创治疗复发性肩关节前脱位的临床疗效比较.骨科,2024,15(4): 320-326. |
| 经腋窝入路开放手术与关节镜下微创治疗复发性肩关节前脱位的临床疗效比较 |
| Comparison of Clinical Efficacy between Open Surgery via Axillary Approach and Arthroscopic Minimally Invasive Treatment for Recurrent Anterior Shoulder Dislocation |
| 投稿时间：2023-08-11 |
| DOI：10.3969/j.issn.1674-8573.2024.04.006 |
| 中文关键词: 腋窝入路 自体髂骨移植 复发性肩关节前脱位 肩关节功能 |
| 英文关键词: Axillary approach Autogenous iliac bone graft Recurrent anterior dislocation of shoulder joint Shoulder joint function |
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| 中文摘要: |
| 目的 对比经腋窝入路开放手术与关节镜下微创治疗复发性肩关节前脱位的临床疗效。方法 回顾性分析2015年4月至2022年4月我院手术治疗的37例复发性肩关节前脱位病人的临床资料。根据手术方法的不同，将行腋窝入路自体髂骨移植+Bankart修复重建的18例病人纳入开放组，关节镜下自体髂骨移植+Bankart修复重建的19例病人纳入微创组。观察两组病人手术时间、术中出血量、切口总长度、住院时间和住院费用；术前、术后1周、6个月、12个月的疼痛视觉模拟量表（visual analogue scale，VAS）评分；术后12个月的Rowe肩关节功能量表、牛津大学肩关节不稳评分（Oxford Shoulder Instability Score，OSIS）和西安大略肩关节不稳指数（Western Ontario Shoulder Instability Index，WOSI）、肩关节活动度和并发症情况。结果 开放组的手术时间和住院费用优于微创组，差异有统计学意义（P＜0.05）；微创组的术中出血量、切口总长度及住院时间优于开放组，差异有统计学意义（P＜0.05）。术后1周和6个月，微创组的VAS评分优于开放组，差异有统计学意义（P＜0.05）。术后12个月，微创组肩关节外展活动度优于开放组（P＜0.05），两组在前屈上举、体侧外旋、90°外旋、体侧内旋、90°内旋活动度方面，差异均无统计学意义（P＞0.05）。两组的Rowe总分、OSIS评分、WOSI评分和并发症发生率比较，差异均无统计学意义（P＞0.05）。结论 经腋窝入路开放手术较关节镜下微创治疗复发性肩关节前脱位，手术时间短，住院费用少，术后肩关节稳定性恢复较好，值得在基层医疗机构中推广应用。 |
| 英文摘要: |
| Objective To compare the clinical efficacy between open surgery via axillary approach and arthroscopic minimally invasive treatment for recurrent anterior shoulder dislocation. Methods A retrospective analysis was performed on 37 patients with recurrent anterior shoulder dislocation who underwent surgical treatment in our hospital from April 2015 to April 2022. According to different surgical methods, 18 patients who underwent axillary approach autologous iliac bone grafting + Bankart repair and reconstruction were included in the open group, and 19 patients who underwent arthroscopic autologous iliac bone grafting + Bankart repair and reconstruction were included in the minimally invasive group. The surgical time, intraoperative blood loss, total incision length, length of hospital stay, and hospitalization expenses of two groups were observed. The visual analogue scale (VAS) scores were recorded to assess pain before surgery, 1 week, 6 months, and 12 months after surgery. The recovery of shoulder joint function was evaluated using the Rowe Shoulder Function Scale, Oxford Shoulder Instability Score (OSIS), and Western Ontario Shoulder Instability Index (WOSI) at 12 months postoperatively. The range of motion of the shoulder joint and complications were recorded. Results The surgical time was shorter and hospitalization costs were less in the open group than those in the minimally invasive group, and the difference was statistically significant (P＜0.05). The intraoperative bleeding volume, total incision length, and hospitalization time in the minimally invasive group were significantly reduced as compared with those in the open group (P＜0.05). At 1 week and 6 months after surgery, the VAS scores in the minimally invasive group were significantly lower than those in the open group (P＜0.05). At 12th month after surgery, the shoulder joint abduction range of motion in the minimally invasive group was bigger than that in the open group (P＜0.05). There was no statistically significant difference (P＞0.05) in the Rowe score, OSIS score, WOSI score, and incidence of complications between the two groups. Conclusion Compared with arthroscopic minimally invasive treatment for recurrent anterior shoulder dislocation, open surgery via axillary approach has shorter operation time, less hospitalization costs, better postoperative shoulder joint stability recovery, and is worthy of promotion and application in primary medical institutions. |
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