CAJ | 학술논문

背景：随着外科技术、重建材料技术的发展，关节置换在肩关节脱位中也得到了广泛应用，特别是各种定制型或装配型假体使得置换适应证明显提高。 　　目的：观察与随访关节镜与关节置换治疗肩关节复发性前脱位伴重度骨缺损的远期疗效。 　　方法：纳入肩关节复发性前脱位伴重度骨缺损患者144例，根据随机抽签分为治疗组与对照组，每组72例。对照组行关节镜下内固定治疗，治疗组行关节置换治疗。通过电话调查与复诊完成3年随访，记录患者Neer肩关节功能评分、肩关节活动度及并发症发生情况。 　　结果与结论：随访3年，治疗组的肩关节功能优良率90%明显高于对照组81%(P <0.05)。两组3年随访时的前屈上举幅度都明显提高，而体侧外旋幅度明显降低，组内对比差异有显著性意义(P<0.05)；同时3年随访时治疗组的前屈上举与体侧外旋幅度与对照组相比差异有显著性意义(P<0.05)。治疗组随访期间的切口感染、肩关节脱位、固定物松动等并发症发生率明显低于对照组(P<0.05)。提示相对于关节镜下内固定治疗，关节置换修复肩关节复发性前脱位伴重度骨缺损在随访远期可明显改善肩关节功能及肩关节活动度，并发症少，从而有效重建肩关节。
배경：수착외과기술、중건재료기술적발전，관절치환재견관절탈위중야득도료엄범응용，특별시각충정제형혹장배형가체사득치환괄응증명현제고。 　　목적：관찰여수방관절경여관절치환치료견관절복발성전탈위반중도골결손적원기료효。 　　방법：납입견관절복발성전탈위반중도골결손환자144례，근거수궤추첨분위치료조여대조조，매조72례。대조조행관절경하내고정치료，치료조행관절치환치료。통과전화조사여복진완성3년수방，기록환자Neer견관절공능평분、견관절활동도급병발증발생정황。 　　결과여결론：수방3년，치료조적견관절공능우량솔90%명현고우대조조81%(P <0.05)。량조3년수방시적전굴상거폭도도명현제고，이체측외선폭도명현강저，조내대비차이유현저성의의(P<0.05)；동시3년수방시치료조적전굴상거여체측외선폭도여대조조상비차이유현저성의의(P<0.05)。치료조수방기간적절구감염、견관절탈위、고정물송동등병발증발생솔명현저우대조조(P<0.05)。제시상대우관절경하내고정치료，관절치환수복견관절복발성전탈위반중도골결손재수방원기가명현개선견관절공능급견관절활동도，병발증소，종이유효중건견관절。
BACKGROUND:With the development of surgical techniques and reconstruction material technology, joint replacement has also been widely used in the dislocation of the shoulder;especial y al kinds of custom-made or assembled prosthesis make replacement indications improved evidently. OBJECTIVE:To investigate the long-term effects of arthroscopy or arthroplasty for treating recurrent anterior dislocation of the shoulder joint with severe bone defects. METHODS:144 patients with recurrent anterior dislocation of the shoulder joint with severe bone defects were enrol ed in this study. They were divided into treatment group and control group based on a random drawing (n=72). The control group was given arthroscopic surgery, and the treatment group was subjected to arthroplasty. The 3 years of fol owed-up were done by telephone investigation and further consultation. Neer shoulder score, shoulder activity and complications were recorded. RESULTS AND CONCLUSION:After 3-year fol owed-up, the excel ent and good rate of shoulder function was significantly higher in the treatment group (90%) than in the control group (81%) (P<0.05). The magnitude of the flexion in the 3-year fol owed-up was apparently increased, while the lateral margin external rotation was decreased, which showed significant differences after intragroup comparison (P<0.05). Simultaneously, the magnitude of the flexion and the lateral margin external rotation in the treatment group had statistical y significant differences compared to the control group in the 3-year fol owed-up (P<0.05). The complications of wound infection, shoulder dislocation, and implant loosening in the treatment group during fol ow-up were significantly lower than in the control group (P<0.05). These findings verified that compared with arthroscopic surgery, arthroplasty for treating recurrent anterior dislocation of the shoulder joint with severe bone defects in long-term fol ow-up can effectively restore shoulder function and range of motion, and it has few complications, thereby effectively rebuilds shoulder joint.