CAJ | 학술논문

目的：探讨改良关节镜下喙突移位Latarjet手术的技术特点及手术效果。方法：关节镜下Latarjet手术是治疗复杂肩关节前方不稳定的有效方法，而经典的关节镜下Latarjet手术没有进行前方关节囊的重建，且术中对肩胛下肌破坏较明显。从2013年2月开始，北京积水潭医院运动损伤科对经典关节镜下Latarjet手术进行改良，术中加入前方关节囊重建术，并采取经腱腹结合部位分离肩胛下肌的技术充分保护肩胛下肌，术后第2天行CT检查评价骨移植物位置。结果：2013年2月至2014年8月，共有51例肩关节前向不稳定患者行改良后的关节镜下Latar-jet手术，所有患者手术均顺利完成，术后CT显示，骨块与肩盂平齐的病例为48例（94．1％），偏内侧病例3例（5．9％）。骨块位于2点至5点位置的病例49例占96．0％，高于2点位置1例占2．0％，低于5点位置1例占2．0％。术后随访未发现复发脱位及半脱位。结论：改良关节镜下Latarjet手术不仅可按照经典切开术式进行操作，同时又能兼具关节镜下手术的微创、精细等优势，喙突骨块可达到良好的位置，手术结果满意。
목적：탐토개량관절경하훼돌이위Latarjet수술적기술특점급수술효과。방법：관절경하Latarjet수술시치료복잡견관절전방불은정적유효방법，이경전적관절경하Latarjet수술몰유진행전방관절낭적중건，차술중대견갑하기파배교명현。종2013년2월개시，북경적수담의원운동손상과대경전관절경하Latarjet수술진행개량，술중가입전방관절낭중건술，병채취경건복결합부위분리견갑하기적기술충분보호견갑하기，술후제2천행CT검사평개골이식물위치。결과：2013년2월지2014년8월，공유51례견관절전향불은정환자행개량후적관절경하Latar-jet수술，소유환자수술균순리완성，술후CT현시，골괴여견우평제적병례위48례（94．1％），편내측병례3례（5．9％）。골괴위우2점지5점위치적병례49례점96．0％，고우2점위치1례점2．0％，저우5점위치1례점2．0％。술후수방미발현복발탈위급반탈위。결론：개량관절경하Latarjet수술불부가안조경전절개술식진행조작，동시우능겸구관절경하수술적미창、정세등우세，훼돌골괴가체도량호적위치，수술결과만의。
Objective:To present the surgical technique and to evaluate the results of the modified ar-throscopic Latarjet procedure.Methods: Arthroscopic Latarjet procedure has proven to be a reliable method of treatment for difficult anteroinferior instability of the shoulder joint.However, there is no ante-rior capsule reattachment and too much subscapularis damage for the classic procedure.From February 2013 , we modified the classic procedure with reattachment of anterior joint capsule and muscle-tendon junction splitting of subscapularis.Coracoid graft position was evaluated using CT scanning.Results:From March 2012 to August 2014, 51 modified Latarjet procedures were successfully performed arthro-scopically for patients with anterior shoulder instability.According to the CT scanning at the final follow up, the graft was flush with the glenoid in 94.1%, and medially placed in 5.9%.Vertical positioning was perfect in 96.0%(2 to 5 o’clock), too high in 2.0%, and too low in 2.0%.There were no cases of recurrent dislocation or subluxation.Conclusion: The modified arthroscopic Latarjet procedure has shown satisfactory results with good graft positioning.It is a minimal invasive and accurate approach, which combines the advantages of the open procedure.