CAJ | 학술논문

目的：通过病例随访研究总结应用切开Latarjet手术治疗复发性肩关节前脱位的临床疗效。方法：随访22例应用切开Latarjet手术治疗的合并明显肩盂前缘骨缺损的复发性肩关节前脱位患者，平均随访时间为66．0个月。在术前拍摄肩关节X线片以及三维CT以评估术前肩关节骨性关节炎及肩盂骨缺损的严重程度。对患者进行体格检查并采用美国肩肘外科协会（ American Shoulder&Elbow Surgeons’ score，ASES）、Constant-Murley和Rowe评分评估肩关节功能及稳定性。术后即刻拍摄肩关节三维CT以检查移位喙突骨块所固定位置。最终随访时，再次拍摄肩关节X线片和三维CT以评估肩关节退行性变的严重程度和喙突骨块的愈合情况，对患者进行体格检查并以前述3种评分标准评价肩关节功能及稳定性。结果：术前患肢平均主动前屈上举158．2°±28．7°，体侧外旋55．3°±15．2°，内旋达T10水平（T3～臀部）；平均肩关节ASES评分77．6±17．5，Constant-Murley评分88．3±12．5， Rowe评分40．2±12．0。最终随访时，无患者出现肩关节复发脱位，肩关节平均主动前屈上举167．7°±12．7°，体侧外旋54．3°±16．5°，内旋达 T10水平（T3～L3），与术前相比差异均无统计学意义（P ＝0．138，P ＝0．765， P＝0．439）；平均ASES评分93．7±9．1，Constant-Murley评分95．6±5．6，Rowe评分96．4±4．4，均较术前明显改善（P＝0．001，P＝0．008，P＜0．001）。随访过程中3例患者肩关节退行性改变较术前加重，1例移位喙突骨块不愈合。结论：切开Latarjet手术对合并明显肩盂骨缺损的复发性肩关节前脱位患者有效，术后5年随访观察未发现肩关节骨性关节炎显著加重。
목적：통과병례수방연구총결응용절개Latarjet수술치료복발성견관절전탈위적림상료효。방법：수방22례응용절개Latarjet수술치료적합병명현견우전연골결손적복발성견관절전탈위환자，평균수방시간위66．0개월。재술전박섭견관절X선편이급삼유CT이평고술전견관절골성관절염급견우골결손적엄중정도。대환자진행체격검사병채용미국견주외과협회（ American Shoulder&Elbow Surgeons’ score，ASES）、Constant-Murley화Rowe평분평고견관절공능급은정성。술후즉각박섭견관절삼유CT이검사이위훼돌골괴소고정위치。최종수방시，재차박섭견관절X선편화삼유CT이평고견관절퇴행성변적엄중정도화훼돌골괴적유합정황，대환자진행체격검사병이전술3충평분표준평개견관절공능급은정성。결과：술전환지평균주동전굴상거158．2°±28．7°，체측외선55．3°±15．2°，내선체T10수평（T3～둔부）；평균견관절ASES평분77．6±17．5，Constant-Murley평분88．3±12．5， Rowe평분40．2±12．0。최종수방시，무환자출현견관절복발탈위，견관절평균주동전굴상거167．7°±12．7°，체측외선54．3°±16．5°，내선체 T10수평（T3～L3），여술전상비차이균무통계학의의（P ＝0．138，P ＝0．765， P＝0．439）；평균ASES평분93．7±9．1，Constant-Murley평분95．6±5．6，Rowe평분96．4±4．4，균교술전명현개선（P＝0．001，P＝0．008，P＜0．001）。수방과정중3례환자견관절퇴행성개변교술전가중，1례이위훼돌골괴불유합。결론：절개Latarjet수술대합병명현견우골결손적복발성견관절전탈위환자유효，술후5년수방관찰미발현견관절골성관절염현저가중。
Objective: To investigate the results of treating patients with recurrent anterior shoulder dislocation using open Latarjet technique in a retrospective study, and to discuss the detail of the surgical technique and the results of the procedure.Methods: In the study, 22 patients with recurrent anterior shoulder dislocation treated with open Latarjet technique were followed up.The average duration of the follow-up was 66.0 months.An X-ray film and a CT scan were performed before the surgery to evaluate the degenerative change of the gleno-humeral joint and the bony defect of the glenoid.An X-ray film and a CT scan were repeated at the end of the final follow-up to find out if there was any progression of the de-generative change of the gleno-humeral joint and if the transferred coracoid process united.Physical ex-aminations, American Shoulder & Elbow Surgeons ( ASES ) score, Constant-Murley score and Rowe questionnaire were used to evaluate the patients’ shoulder function before the surgery and at the end of the final follow-up.Results:Before the surgery the average forward elevation, external rotation and inter-nal rotation were 158.2°±28.7°, 55.3°±15.2°and T10 ( T3 -buttock) respectively.The average ASES score, Constant-Murley score and Rowe score were 77.6 ±17.5, 88.3 ±12.5 and 40.2 ±12.0, respectively.At the end of the final follow-up, no redislocation happened.The average forward eleva-tion, external rotation and internal rotation were 167.7°±12.7°, 54.3°±16.5°and T10 (T3-L3), respectively(P=0.138, P=0.765, P=0.439).No sigificant restriction was detected after the surgery regarding forward elevation,external rotation and internal rotation.The mean ASES score, Constant-Mur-ley score, and Rowe score significantly improved to 93.7 ±9.1 (P=0.001), 95.6 ±5.6 (P=0.008) and 96.4 ±4.4 (P<0.001) respectively after the surgery.A progression of the degenerative change of the gleno-humeral joint was detected in 3 patients.A non-union of the transferred coarcoid was detected in 1 patient.Conclusion:Open Latarjet procedure is effective in treating the recurrent anterior shoulder dislocation patient with severe glenoid defect.No significant progression of the degenerative change of the gleno-humeral joint is detected in average 5-year follow-up.