摘要
[目的]探索采用自体肩胛冈骨块移植,同种异体骨横穿钉固定修复骨性Bankart损伤。[方法]根据探查和术前肩关节CT扫描三维重建骨缺损情况,关节镜探查确认肩关节骨性Bankart损伤。取自体肩胛冈外1/3骨块,将骨块修整后钻孔,移植到肩盂骨性缺损处,采用同种异体骨横钉将骨块固定在肩盂缺损处。骨钉头端穿入缝线,捆扎缝合软组织及骨块。采用美国肩肘外科评分、Rows评分和CT扫描三维重建及X线片等影像学检查评价肩关节的稳定性和功能。[结果]共5例患者,美国肩肘外科评分由术前(4.20±1.10)分增加至末次随访时(12.4±0.55)分。Rows评分由术前(13.00±4.47)分增加至末次随访时(93.00±2.74)分。[结论]采用自体肩胛冈骨块移植、同种异体骨钉固定修复骨性Bankart损伤,骨块取材方便,生物骨钉固定牢固,免用高值耗材,方法可行。
[Objective] To explore the technique of bone autograft from scapular spine fixed with bone cortical allograft pin for repairing bony Bankart lesion.[Methods] Based on preoperative CT scan that revealed glenoid bony defect,arthroscopic exploration was conducted to confirm the bony Bankart lesions further.After that,a bone block harvested from the lateral third scapular spine was trimmed,drilled two holes on it and then implanted on the glenoid defect.Lastly,the bone block was secured with the glenoid by transversely tapping two bone cortical allograft pins,in which sutures through the pin hole at top part were eventually stitched with the surrounding capsule.The American Shoulder and Elbow Surgery Scores,Rows Rating System for Bankart repair,the reconstruction of 3D-CT scan and X-ray images were used to evaluate the stability and function of the shoulder joint.[Results] A total of 5 patients underwent this procedure.The American Shoulder and Elbow Surgery Scores significantly increased from(4.20±1.10) before surgery to(12.4±0.55) at the latest follow-up,additionally,the Rows scores increased from(13.00±4.47) before surgery to(93.00±2.74) at the latest follow-up.[Conclusion] This technique of bone autograft from scapular spine fixed with bone cortical allograft pin is clinically feasible for repairing bony Bankart lesion with benefits of bone autograft accessible and fixation with biocompatible material.
引文
[1]Ee GW,Mohamed S,Tan AH.Long term results of arthroscopic Bankart repair for traumatic anterior shoulder instability[J].J Orthop Surg Res,2011,6(1):28.
[2]Kim YK,Cho SH,Son WS,et al.Arthroscopic repair of small and medium-sized bony Bankart lesions[J].Am J Sports Med,2014,42(1):86-94.
[3]黄长明.骨性Bankart损伤的修复[J/CD].中华肩肘外科电子杂志,2016,4(1):56-60.
[4]孙贺.肩胛骨的应用解剖学研究暨肩胛骨骨折的治疗[D].石家庄:河北医科大学,2012.
[5]Schaaf H,Lendeckel S,Howaldt HP,et al.Donor site morbidity after bone harvesting from the anterior iliac crest[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2010,109(1):52-58.
[6]Zhao J,Huangfu X,Yang X,et al.Arthroscopic glenoid bone grafting with nonrigid fixation for anterior shoulder instability:52 patients with 2-to 5-year follow-up[J].Am J Sports Med,2014,42(4):831-839.
[7]Griesser MJ,Harris JD,Mc Coy BW,et al.Complications and reoperations after Bristow-Latarjet shoulder stabilization:a systematic review[J].J Shoulder Elbow Surg,2013,22:286-292.
[8]Griesser MJ,Harris JD,Mc Coy BW,et al.Glenoid fracture after Bristow-Latarjet shoulder stabilization:a case report and review of the literature[J].J Shoulder Elbow Surg,2013,22(1):17-20.
[9]Younger EM,Chapman MW.Morbidity at bone graft donor sites[J].J Orthop Trauma,1989,3:192-195.
[10]Summers BN,Eisenstein SM.Donor site pain from the ilium.A complication of lumbar spine fusion[J].J Bone Joint Surg Br,1989,71(4):677-680.
[11]李伟.肩胛骨的解剖学研究[D].广州:南方医科大学,2007.
[12]Bevevino AJ,Kang DG,Lehman RA Jr,et al.Systematic review and meta-analysis of minimally invasive transforaminal lumbar interbody fusion rates performed without posterolateral fusion[J].J Clin Neurosci,2014,21(26):1686-1690.
[13]潘剑成,龚旭,罗飞.同种异体骨椎间融合器的研究进展及临床应用现状[J].中国修复重建外科杂志,2015,29:381-385.
[14]Gazdag AR,Lane JM,Glaser D,et al.Alternatives to Autogenous Bone Graft:Efficacy and Indications[J].J Am Acad Orthop Surg,1995,3(1):1-8.
[15]李光辉,刘玉杰,孙明学,等.皮质骨锚钉修复肩关节不稳的生物力学研究[J].军医进修学院学报,2007,128(6):435-436.
