关节镜下关节囊修补术治疗复发性肩关节前脱位合并HAGL损伤的临床疗效
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摘要
目的:探讨关节镜下关节囊修补术对复发性肩关节前脱位合并盂肱关节下韧带自肱骨附着点的撕脱(humeral avulsion of glenohumeral ligament,HAGL)损伤的临床疗效。方法:应用关节镜下关节囊修补术治疗合并HAGL损伤的复发性肩关节前脱位患者9例,平均随访时间24.2个月。分别于术前、术后对患者进行体格检查,并采用美国肩肘外科协会评分(American Shoulder&Elbow Surgeons’score,ASES)、Constant-Murley评分和Rowe评分以及是否存在术后再脱位或残存恐惧试验阳性来评价肩关节功能。结果:我院复发性肩关节前脱位患者中HAGL损伤的发病率为0.8%。合并HAGL损伤的复发性肩关节前脱位患者术前患肢主动前屈146.1±43.3°,体侧外旋53.9±8.6°,内旋达到T12(T7～LS);肩关节ASES评分76.8±21.9,Constant-Murley评分81.2±15.8,Rowe评分39.4±6.3。末次随访时,无患者出现肩关节复发脱位,恐惧试验皆为阴性;肩关节主动前屈163.2±13.2°,体侧外旋58.9±3.3°,内旋达T12(T7～L3),与术前相比差异均无统计学意义(P=0.068,P=0.157,P=0.180);ASES评分91.4±7.4,Constant-Murley评分91.6±7.5,Rowe评分94.4±8.1,均较术前显著改善(P<0.05)。结论:HAGL损伤是复发性肩关节前脱位患者中较为罕见的损伤类型。关节镜下关节囊修补术治疗合并HAGL损伤的复发性肩关节前脱位患者可取得满意的临床疗效。
Objective To explore the clinical outcome of the arthroscopic humeral avulsion of glenohumeral lig-ament(HAGL) repair in patients suffering from anterior shoulder instability associated with HAGL lesion. Methods A total of 9 patients with anterior shoulder instability and HAGL lesion undergoing the arthroscopic humer-al avulsion were followed up for a mean of 24.2 months. Before the operation and at the final follow-up,theywere given physical examination and evaluated the function of shoulders using the American Shoulder & ElbowSurgeons' score(ASES), Constant-Murley score and Rowe score. Results For patients with recurrent anteriorshoulder instability,the incidence of HAGL lesion was 0.8%. For the 9 patients,no significant difference wasobserved in the range of motion of the affected shoulder before the operation and at the final follow-up withthe initiative anteflexion angle of 146.1 ± 43.3° and 163.2 ± 13.2°,the lateral extorsion angle of 53.9 ± 8.6°and 58.9 ± 3.3° and internal rotation to T12(T7～LS) and T12(T7～L3). No recurrent anterior shoulder instabil-ity occurred during the last follow-up. However, significant improvement was observed in the average ASESscore,Constant-Murley score and Rowe score from 76.8 ± 21.9,81.2 ± 15.8 and 39.4 ± 6.3 to 91.4 ± 7.4,91.6 ± 7.5,and 94.4 ± 8.1 respectively(P<0.05). Conclusion HAGL lesion is rare in patients with the anterior shoulder instability,of a 0.8% occurrence rate in our study. Arthroscopic HAGL repair is an effective techniquefor the treatment of anterior shoulder instability with HAGL lesion.
Objective To explore the clinical outcome of the arthroscopic humeral avulsion of glenohumeral lig-ament(HAGL) repair in patients suffering from anterior shoulder instability associated with HAGL lesion. Methods A total of 9 patients with anterior shoulder instability and HAGL lesion undergoing the arthroscopic humer-al avulsion were followed up for a mean of 24.2 months. Before the operation and at the final follow-up,theywere given physical examination and evaluated the function of shoulders using the American Shoulder & ElbowSurgeons' score(ASES), Constant-Murley score and Rowe score. Results For patients with recurrent anteriorshoulder instability,the incidence of HAGL lesion was 0.8%. For the 9 patients,no significant difference wasobserved in the range of motion of the affected shoulder before the operation and at the final follow-up withthe initiative anteflexion angle of 146.1 ± 43.3° and 163.2 ± 13.2°,the lateral extorsion angle of 53.9 ± 8.6°and 58.9 ± 3.3° and internal rotation to T12(T7～LS) and T12(T7～L3). No recurrent anterior shoulder instabil-ity occurred during the last follow-up. However, significant improvement was observed in the average ASESscore,Constant-Murley score and Rowe score from 76.8 ± 21.9,81.2 ± 15.8 and 39.4 ± 6.3 to 91.4 ± 7.4,91.6 ± 7.5,and 94.4 ± 8.1 respectively(P<0.05). Conclusion HAGL lesion is rare in patients with the anterior shoulder instability,of a 0.8% occurrence rate in our study. Arthroscopic HAGL repair is an effective techniquefor the treatment of anterior shoulder instability with HAGL lesion.
引文
[1]Bokor DJ,Conboy VB,Olson C.Anterior instability o the glenohumeral joint with humeral avulsion of the glenohumeral ligament.A review of 41 cases.J Bone Join Surg Br,1999,81(1):93-96.
[2]Bui-Mansfield LT,Taylor DC,Uhorchak JM,et al.Humeral avulsion of the glenohumeral ligament:Imaging features and a review of the literature.AJR Am J Roentgenol,2002,179(3):649-655.
[3]Schippinger G,Vasiu PS,Fankhauser F,et al.HAGLlesion occurring after successful arthroscopic Bankart repair.Arthroscopy,2001,17(2):206-208.
[4]Warner JJ,Beim GM.Combined Bankart and HAGL lesion associated with anterior shoulder instability.Arthroscopy,1997,13(6):749-752.
[5]Wolf EM,Cheng JC,Dickson K.Humeral avulsion of the glenohumeral ligaments as a cause of anterior shoulder instability.Arthroscopy,1995,11(5):600-607.
[6]Field LD,Bakoz DJ,Savoie FH.Humeral and glenoid detachment of the anterior inferior glenohumeral ligament:A cause of anterior instability.J Shoulder Elbow Surg,1997,6(1):6-10.
[7]Tirman PF,Steinbach LS,Feller JF,et al.Humeral avulsion of the anterior shoulder stabilizing structures after anterior shoulder dislocation:demonstration by MRIand MR arthrography.Skeletal Radiol,1996,25(8):743-748.
[8]Bach BR,Warren RF,Froner J.Disruption of the lateral capsule of the shoulder:a cause of recurrent dislocation.J Bone Joint Surg Br,1988,70(2):274-276.
[9]Turkel SJ,Panio MW,Marshall JL,et al.Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint.J Bone Joint Surg Am,1981,63(8):1208-1217.
[10]O’Brien SJ,Neves MC,Arnoczky SP,et al.The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder.Am J Sports Med,1990,18(5):449-456.
[12]Nicola T.Anterior dislocation of the shoulder.J Bone Joint Surg Am,1949,31A(1):153-159.
[13]Longo UG,Rizzello G,Ciuffreda M,et al.Humeral avulsion of the glenohumeral ligaments:A systematic review.Arthroscopy,2016,32(9):1868-1876.
[14]Park KJ,Tamboli M,Nguyen LY,et al.A large humeral avulsion of the glenohumeral ligaments decreases stability that can be restored with repair.Clin Orthop Relat Res,2014,472(8):2372-2379.
[15]Stoller DW.MR arthrography of the glenohumeral joint.Radiol Clin N Am,1997,35(1):97-116.
[16]Magee T.Prevalence of HAGL lesions and associated abnormalities on shoulder MR examination.Skeletal Radiol,2014,43(3):307-313.
[17]Provencher MT,McCormick F,LeClere L,et al.Prospective evaluation of surgical treatment of humeral avulsions of the glenohumeral ligament.Am J Sports Med,2017,45(5):1134-1140.
[18]Spang JT,Karas SG.The HAGL lesion:an arthroscopic technique for repair of humeral avulsion of the glenohumeral ligaments.Arthroscopy,2005,21(4):498-502.
[19]Flury M,Rickenbacher D,AudigéL.Arthroscopic treatment of anterior shoulder instability associated with a HAGL lesion-a case series.J Shoulder Elbow Surg,2016,25(12):1989-1996.
[20]Bhatia DN,DasGupta B.Surgical treatment of significant glenoid bone defects and associated humeral avulsions of glenohumeral ligament(HAGL)lesions in anterior shoulder instability.Knee Surg Sports Traumatol Arthrosc,2013,21(7):1603-1609.
[21]Fritz EM,Pogorzelski J,Hussain ZB,et al.Arthroscopic repair of humeral avulsion of the glenohumeral ligament lesion.Arthrosc Tech,2017,6(4):e1195-e1200.
[2]Bui-Mansfield LT,Taylor DC,Uhorchak JM,et al.Humeral avulsion of the glenohumeral ligament:Imaging features and a review of the literature.AJR Am J Roentgenol,2002,179(3):649-655.
[3]Schippinger G,Vasiu PS,Fankhauser F,et al.HAGLlesion occurring after successful arthroscopic Bankart repair.Arthroscopy,2001,17(2):206-208.
[4]Warner JJ,Beim GM.Combined Bankart and HAGL lesion associated with anterior shoulder instability.Arthroscopy,1997,13(6):749-752.
[5]Wolf EM,Cheng JC,Dickson K.Humeral avulsion of the glenohumeral ligaments as a cause of anterior shoulder instability.Arthroscopy,1995,11(5):600-607.
[6]Field LD,Bakoz DJ,Savoie FH.Humeral and glenoid detachment of the anterior inferior glenohumeral ligament:A cause of anterior instability.J Shoulder Elbow Surg,1997,6(1):6-10.
[7]Tirman PF,Steinbach LS,Feller JF,et al.Humeral avulsion of the anterior shoulder stabilizing structures after anterior shoulder dislocation:demonstration by MRIand MR arthrography.Skeletal Radiol,1996,25(8):743-748.
[8]Bach BR,Warren RF,Froner J.Disruption of the lateral capsule of the shoulder:a cause of recurrent dislocation.J Bone Joint Surg Br,1988,70(2):274-276.
[9]Turkel SJ,Panio MW,Marshall JL,et al.Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint.J Bone Joint Surg Am,1981,63(8):1208-1217.
[10]O’Brien SJ,Neves MC,Arnoczky SP,et al.The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder.Am J Sports Med,1990,18(5):449-456.
[12]Nicola T.Anterior dislocation of the shoulder.J Bone Joint Surg Am,1949,31A(1):153-159.
[13]Longo UG,Rizzello G,Ciuffreda M,et al.Humeral avulsion of the glenohumeral ligaments:A systematic review.Arthroscopy,2016,32(9):1868-1876.
[14]Park KJ,Tamboli M,Nguyen LY,et al.A large humeral avulsion of the glenohumeral ligaments decreases stability that can be restored with repair.Clin Orthop Relat Res,2014,472(8):2372-2379.
[15]Stoller DW.MR arthrography of the glenohumeral joint.Radiol Clin N Am,1997,35(1):97-116.
[16]Magee T.Prevalence of HAGL lesions and associated abnormalities on shoulder MR examination.Skeletal Radiol,2014,43(3):307-313.
[17]Provencher MT,McCormick F,LeClere L,et al.Prospective evaluation of surgical treatment of humeral avulsions of the glenohumeral ligament.Am J Sports Med,2017,45(5):1134-1140.
[18]Spang JT,Karas SG.The HAGL lesion:an arthroscopic technique for repair of humeral avulsion of the glenohumeral ligaments.Arthroscopy,2005,21(4):498-502.
[19]Flury M,Rickenbacher D,AudigéL.Arthroscopic treatment of anterior shoulder instability associated with a HAGL lesion-a case series.J Shoulder Elbow Surg,2016,25(12):1989-1996.
[20]Bhatia DN,DasGupta B.Surgical treatment of significant glenoid bone defects and associated humeral avulsions of glenohumeral ligament(HAGL)lesions in anterior shoulder instability.Knee Surg Sports Traumatol Arthrosc,2013,21(7):1603-1609.
[21]Fritz EM,Pogorzelski J,Hussain ZB,et al.Arthroscopic repair of humeral avulsion of the glenohumeral ligament lesion.Arthrosc Tech,2017,6(4):e1195-e1200.