關(guān)節(jié)鏡手術(shù)與保守治療青年人群初次肩關(guān)節(jié)前脫位的臨床療效

高硯文　徐叢　呂永明

摘 要：目的 比較關(guān)節(jié)鏡手術(shù)與保守方法治療青年人群初次肩關(guān)節(jié)前脫位的臨床療效。方法 回顧性分析2010年1月～2013年7月我院64例診斷為急性初次肩關(guān)節(jié)前肩脫位的患者資料。其中32例患者行關(guān)節(jié)鏡修復(fù)術(shù)為關(guān)節(jié)鏡手術(shù)組，32例患者行保守治療為保守治療組，隨訪5年。比較兩組WOSI指數(shù)評分，肩膀、手和手臂的殘疾評分。結(jié)果 保守治療組23例患者在5～18個月后發(fā)生再次脫位；關(guān)節(jié)鏡手術(shù)組僅有2例患者在術(shù)后1年出現(xiàn)再次脫位。隨訪18個月后，關(guān)節(jié)鏡手術(shù)組患者WOSI評分、DASH評分均高于保守治療組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；末次隨訪顯示，兩組患者（包括復(fù)發(fā)性脫位進(jìn)行關(guān)節(jié)鏡穩(wěn)定術(shù)患者）WOSI評分、DASH評分比較，差異無統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論 關(guān)節(jié)鏡手術(shù)治療青年人群初次肩關(guān)節(jié)前脫位的復(fù)發(fā)率較低，患者肩關(guān)節(jié)穩(wěn)定性較好，肩膀及手功能恢復(fù)較好。

關(guān)鍵詞：青年人群；肩關(guān)節(jié)；關(guān)節(jié)鏡；初次前脫位

中圖分類號：R684.7 文獻(xiàn)標(biāo)識碼：A DOI：10.3969/j.issn.1006-1959.2018.22.020

文章編號：1006-1959（2018）22-0073-04

Clinical Efficacy of Arthroscopic Surgery and Conservative Treatment of Initial Anterior Shoulder Dislocation in Young People

GAO Yan-wen1，2，XU Cong2，LV Yong-ming2

（1.Graduate School of Chengde Medical College，Chengde 067000，Hebei，China；

2.Department of Joint Surgery，Affiliated Hospital of Chengde Medical College，Chengde 067000，Hebei，China）

Abstract：Objective To compare the clinical efficacy of arthroscopic surgery and conservative methods in the treatment of initial anterior shoulder dislocation of the young people.Methods A retrospective analysis of 64 patients with a diagnosis of initial anterior shoulder dislocation of the shoulder from January 2010 to July 2013 was performed. Among them， 32 patients underwent arthroscopic surgery for arthroscopic surgery， and 32 patients underwent conservative treatment for conservative treatment. The follow-up period was 5 years. The two groups of WOSI index scores， shoulder， hand and arm disability scores were compared.Results 23 patients in the conservative treatment group were dislocated again after 5 to 18 months. Only 2 patients in the arthroscopic surgery group had dislocation again at 1 year after surgery. After 18 months of follow-up， the WOSI score and DASH score of the arthroscopic surgery group were higher than those of the conservative treatment group， the difference was statistically significant （P<0.05）. The last follow-up showed that the two groups of patients （including recurrent dislocation for arthroscopy）.There were no significant differences in WOSI scores and DASH scores between the patients （P>0.05）. Conclusion Arthroscopic surgery has a lower recurrence rate of initial anterior shoulder dislocation in young people. The shoulder joint stability is better and shoulder and hand function recovery is better.

Key words：Young people；Shoulder joint；Arthroscopy；Initial anterior dislocation

肩關(guān)節(jié)前脫位（scapular dislocation）是年輕人中常見的損傷，占所有主要關(guān)節(jié)脫位的50%[1，2]。肩關(guān)節(jié)脫位的常見并發(fā)癥包括復(fù)發(fā)性不穩(wěn)和半脫位，特別是在接受保守治療的年輕患者中。治療原發(fā)性肩關(guān)節(jié)前肩脫位是復(fù)雜和具有挑戰(zhàn)性的，患者的特定變量包括年齡、職業(yè)、功能要求、體育參與、身體特征和依從性使決定用哪種治療方法進(jìn)一步復(fù)雜化。無論是保守治療還是手術(shù)治療，目標(biāo)是肩關(guān)節(jié)穩(wěn)定、無痛，能夠完全恢復(fù)受傷前的運(yùn)動范圍。本研究旨在研究青年人群初次肩關(guān)節(jié)前脫位的關(guān)節(jié)鏡手術(shù)與保守方法治療的臨床療效。

1 資料與方法

1.1一般資料 選擇承德醫(yī)學(xué)院附屬醫(yī)院2010年1月～2013年7月收治的急性初次肩關(guān)節(jié)前脫位患者64例。……