肩关节镜下改良入路治疗复发性肩关节前脱位

目的：探讨肩关节镜下前方单入路技术治疗复发性肩关节前脱位（肩关节Bankart损伤）的疗效，为克服术中困难、简化手术流程提供一种方案。方法：2016年7月至2019年1月，肩关节镜下治疗复发性肩关节前脱位引起的复发性脱位患者62例，男50例，女12例。年龄19~44（26.5±6.1）岁。左肩25例，右肩37例。患者按手术方式分为两组，前方改良单入路组（35例）和传统经典前方双入路组（27例）。通过术前、术后肩关节美国肩肘协会（American Shoulder and Elbow Surgeons Form，ASES）评分评价手术疗效，记录建立入路及手术整体时间来评价前方改良单入路的手术时间是否缩短。结果：3例术后失访；除1例再次脱位外，所有患者取得满意疗效，无神经血管损伤等并发症。分别于术前及术后3、6、12个月随访患者并进行ASES评分，两组患者随访时ASES评分均较术前升高。建立入路时间前方改良单入路组（7.5±1.5）min，传统经典前方双入路组（13.7±1.2）min，前方改良单入路组较传统经典前方双入路组用时短。结论：肩关节镜下改良入路技术在保证疗效的基础上具有减少切口、缩短手术时间的优势，值得推广应用。

Modified arthroscopic anterior approach for the treatment of shoulder Bankart lesion

Objective: To explore the effects of single anterior approach under shoulder arthroscopy in the treatment of Bankart injury,and to provide a scheme to overcome the difficulties and simplify the operation process.Methods: From July 2016 to January 2019,62 patients with recurrent dislocation caused by Bankart leision were treated under shoulder arthroscopy,including 50 males and 12 females,ranging in age from 19 to 44 years old with an average age of (26.5±6.1) years old. There were 25 cases of left shoulder and 37 cases of right shoulder. The patients were divided into two groups according to the operation mode,35 patients in the front modified single approach group(experimental group) and 27 patients in the traditional double approach group (control group). The results of the operation were evaluated by assessing the preoperative and postoperative ASES scores of the shoulder joint,and the time of the approach establishment and the overall operation process was recorded to evaluate whether the operation time of the experimental group was shortened.Results: Three patients were lost during the follow-up after operation,and except for one case of re-dislocation,all patients achieved satisfactory results without neurovascular injury and other complications. The patients were followed up before operation and 3,6,12 months after operation,and the ASES scores were significantly enhanced at the latest follow-up compared with those of before operation. The time of establishing surgical approach in the experimental group was (7.5±1.5) minutes,which was shorter than that of control group (13.7±1.2) minutes.Conclusion: The improved technique of single-channel anterior approach has the advantages of reducing the surgical incision and shortening the operation time while ensuring the quality of the operation,which is worthy of popularization and application.