本文選題：改良Latarjet術(shù) + 骨質(zhì)缺失　； 參考：《寧夏醫(yī)科大學》2015年碩士論文

【摘要】：目的:探討改良Latarjet術(shù)治療伴有骨質(zhì)缺失的復發(fā)性肩關(guān)節(jié)前脫位的臨床療效。方法:選取寧夏醫(yī)科大學總醫(yī)院創(chuàng)傷骨科2011年2月至2013年9月間就診的伴有骨質(zhì)缺失的復發(fā)性肩關(guān)節(jié)前脫位患者25例為研究對象,通過納入及排除標準排除5例,共有20例伴有骨質(zhì)缺失的復發(fā)性肩關(guān)節(jié)前脫位患者符合納入標準,對20例伴有骨質(zhì)缺失的復發(fā)性肩關(guān)節(jié)前脫位的患者采用肩關(guān)節(jié)Constant-Murley功能評分及Bigliani肩關(guān)節(jié)不穩(wěn)手術(shù)修復后穩(wěn)定性評分以及通過計算喙突移植骨塊的骨性愈合率進行療效評估。結(jié)果:納入研究的20例病人中,有1例失訪,19例獲得完整隨訪,隨訪1到1.5年的時間,(平均15.05個月)。分別在術(shù)后1、3、6、12個月對患者進行隨訪,隨訪內(nèi)容包括肩關(guān)節(jié)X片、CT、肩關(guān)節(jié)功能恢復情況及Constant-Murley、Bigliani肩關(guān)節(jié)功能評分�；紓�(cè)肩關(guān)節(jié)Constant-Murley功能評分從術(shù)前70.15±2.85分提高到術(shù)后92.5±1.73,Bigliani肩關(guān)節(jié)不穩(wěn)手術(shù)修復后穩(wěn)定性評分從術(shù)前3.10±1.71分提高到術(shù)后7.15±0.67,喙突移植骨塊的骨性愈合率為89.4%。隨訪患者術(shù)后肩關(guān)節(jié)穩(wěn)定,無肩關(guān)節(jié)再脫位的發(fā)生,肩關(guān)節(jié)恐懼實驗陰性,術(shù)前、術(shù)后比較,差異有統(tǒng)計學意義(P0.05)。結(jié)論:改良Latarjet術(shù)通過恢復導致復發(fā)性肩關(guān)節(jié)前脫位的靜力性結(jié)構(gòu)和動力性結(jié)構(gòu),徹底杜絕了過去各種手術(shù)方法術(shù)后容易再次復發(fā)的問題。能明顯改善肩關(guān)節(jié)的前方穩(wěn)定性,患者的內(nèi)旋、外旋及前屈上舉等功能明顯改善,尤其是相對于傳統(tǒng)的Latarjet術(shù)極大的減少了肩關(guān)節(jié)外旋功能的丟失。是臨床治療伴有骨質(zhì)缺失的復發(fā)性肩關(guān)節(jié)前脫位的有效手術(shù)方法,對臨床治療該類疾病具有指導意義。
[Abstract]:Objective: to investigate the clinical effect of modified Latarjet in the treatment of recurrent anterior dislocation of shoulder with bone loss. Methods: from February 2011 to September 2013, 25 patients with recurrent anterior dislocation of shoulder joint with bone loss were selected from Department of Orthopedics, General Hospital of Ningxia Medical University, and 5 cases were excluded by inclusion and exclusion criteria. A total of 20 patients with recurrent anterior dislocation of the shoulder with bone loss met the inclusion criteria. Twenty patients with recurrent anterior dislocation of shoulder with bone loss were evaluated with Constant-Murley function score of shoulder joint, stability score of Bigliani shoulder joint instability after operation and bone healing rate of coracoid process graft bone graft. Results: of the 20 patients in the study, 1 case had lost his visit and 19 cases had been followed up for 1 to 1.5 years (mean 15.05 months). The patients were followed-up at 1: 3 and 12 months, respectively. The follow-up included X ray of shoulder, recovery of shoulder function and Constant-Murley Bigliani shoulder function score. The Constant-Murley score of affected shoulder joint increased from 70.15 鹵2.85 before operation to 92.5 鹵1.73 after operation on the shoulder joint instability. The stability score increased from 3.10 鹵1.71 before operation to 7.15 鹵0.67 after operation. The bone healing rate of coracoid bone graft was 89.4. The postoperative shoulder joint stability, no shoulder redislocation, shoulder fear test negative, preoperative and postoperative comparison, the difference was statistically significant (P 0.05). Conclusion: by restoring the static and dynamic structures of recurrent anterior dislocation of shoulder joint, the modified Latarjet procedure has completely eliminated the problem of recurrence easily after operation in the past. It can obviously improve the anterior stability of shoulder joint, and improve the function of internal rotation, external rotation and forward flexion, especially compared with the traditional Latarjet procedure, which greatly reduces the loss of shoulder pronation function. It is an effective surgical method for the treatment of recurrent anterior dislocation of shoulder with bone loss.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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本文編號：1917055