genortГений ортопедииGenij Ortopedii1028-44272542-131XЦЕНТР ИЛИЗАРОВА10.18019/1028-4427-2021-27-3-337-344genort-2643Research ArticleОригинальные статьиOriginal articlesЭффективность современных методик оперативного лечения передней рецидивирующей нестабильности плечевого сустава в зависимости от анатомо-функциональных измененийThe effectiveness of current methods of surgical treatment of anterior recurrent instability of the shoulder joint, depending on anatomical and functional changesЧирковН. Н.ChirkovN. N.

г. Чебоксары

Cheboksary

surgenik@gmail.comНиколаевН. С.NikolaevN. S.

г. Чебоксары

Cheboksary

nikolaevns@mail.ruАлексееваА. В.AlekseevaA. V.

г. Чебоксары

Cheboksary

alexeeva.shokolad@yandex.ruЯковлевВ. Н.YakovlevV. N.

г. Чебоксары

Cheboksary

vnyakovlev@orthoscheb.comЛушинА. В.LushinA. V.

г. Чебоксары

Cheboksary

lushin_cheb@mail.ruФГБУ «Федеральный центр травматологии, ортопедии и эндопротезирования» Минздрава России; ФГБОУ ВО «Чувашский государственный университет имени И.Н. Ульянова»РоссияFederal Center for Traumatology, Orthopedics and Endoprosthetics; Chuvash State University named after I.N. UlyanovRussian FederationФГБУ «Федеральный центр травматологии, ортопедии и эндопротезирования» Минздрава РоссииРоссияFederal Center for Traumatology, Orthopedics and EndoprostheticsRussian FederationФГБОУ ВО «Чувашский государственный университет имени И.Н. Ульянова»РоссияChuvash State University named after I.N. UlyanovRussian Federation202128062021273№ 3 (2021)337344Copyright © Чирков Н.Н., Николаев Н.С., Алексеева А.В., Яковлев В.Н., Лушин А.В., 20212021Чирков Н.Н., Николаев Н.С., Алексеева А.В., Яковлев В.Н., Лушин А.В.Chirkov N.N., Nikolaev N.S., Alekseeva A.V., Yakovlev V.N., Lushin A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ilizarov-journal.com/jour/article/view/2643

Последствием травматического переднего вывиха плеча обычно является формирование хронической рецидивирующей нестабильности, особенно у молодых людей. Для снижения частоты рецидивов вывихов предложены различные варианты костно-пластических операций.

Цель

Цель. Определить значимость анатомо-функциональных нарушений у пациентов с передней нестабильностью плечевого сустава; оценить результаты применения методик оперативного лечения пациентов с данной патологией в зависимости от анатомо-функциональных арушений.

Материалы и методы

Материалы и методы. Проанализированы результаты лечения 169 пациентов с посттравматическим рецидивирующим вывихом плеча, оперированных в ФГБУ «ФЦТОЭ» Минздрава России (г. Чебоксары). Средний возраст пациентов – 31,1 ± 13,1 года, срок послеоперационного наблюдения – 49,5 ± 24,0 мес. Клинические данные оценивались методом ангулометрии, посредством шкал ROWE, ASES, UCLA, ВАШ. Размер костных дефектов определялся методами лучевой диагностики. 58,6 % пациентов выполнена артроскопическая операция Bankart, из 14,2 % пациентов с костным дефектом переднего отдела гленоида более 15 % проведена операция Latarjet. У 23,1 % пациентов выполнено оперативное вмешательство Bankart + Remplissage, у 4,1 % – Latarjet + Remplissage.

Результаты

Результаты. Костный дефект гленоида более 15 % площади выявлен у 18,9 % пациентов. Повреждение Hill-Sachs 3 степени зарегистрировано у 14,2 % пациентов. Большинство этих пациентов имели более 20 эпизодов вывихов в анамнезе. Гиперэластичность плечевого сустава выявлена у 34 (20,1 %) человек. В послеоперационном периоде отмечалось незначительное улучшение средних показателей сгибания и отведения в плечевом суставе от 174,2 ± 15,9° и 170,6 ± 17,8° до 175,6 ± 9,3° и 173,0 ± 12,3°. Средняя наружная ротация уменьшилась с 61,6 ± 25,7° до 55,9 ± 14,4°. Показатели оценочных шкал ROWE, ASES, UCLA значительно улучшились с 38,5 ± 8,5, 76,0 ± 13,2 и 20,8 ± 3,0 до 89,9 ± 17,5, 94,0 ± 7,1 и 32,7 ± 3,7 балла соответственно. Неудовлетворительный результат отмечен у 7 пациентов (4,1 %), из них рецидив зафиксирован у троих.

Выводы

Выводы. Критически значимыми анатомо-функциональными нарушениями у пациентов с передней нестабильностью плечевого сустава являются дефект переднего края суставного отростка лопатки более 15 %, дефект задней поверхности головки плечевой кости Hill-Sachs 3 степени, гиперэластичность мягких тканей плечевого сустава. Выраженность костных дефектов прямо пропорциональна общему количеству вывихов. Эффективность применения оперативных методик стабилизации плечевого сустава в зависимости от анатомо-функциональных нарушений составляет 95,9 %. 

Introduction

Introduction. Traumatic anterior dislocation of the shoulder usually results in chronic recurrent shoulder instability, especially in young adults. To reduce the rate of recurrent dislocations, various options of osteoplastic operations have been proposed.

The purpose of our study is to determine the significance of anatomical and functional disorders in patients with anterior shoulder joint instability; to evaluate the results of the methods for surgical treatment of patients with anterior recurrent instability of the shoulder joint, depending on the anatomical and functional disorders.

Materials and methods

Materials and methods. The results of diagnostic examination and treatment of 169 patients with recurrent post-traumatic dislocation of the shoulder who were operated on at the Federal State Budgetary Organization “Federal Center for Traumatology, Orthopedics and Arthroplasty” (Cheboksary) were analyzed. The average age of patients was 31.1 ± 13.1 years; the average period of postoperative follow-up was 49.5 ± 24.0 months. Clinical data were assessed by angulometry, using the ROWE, ASES, UCLA, VAS scales. The size of bone defects was determined using radiological methods. 99 patients (58.6 %) underwent arthroscopic Bankart repair, 24 patients (14.2 %) with more than 15 % anterior glenoid bone defect underwent Latarjet operation. Bankart + Remplissage surgery was performed in 39 patients (23.1 %), Latarjet + Remplissage in 7 (4.1 %) patients.

Results

Results. Bone defect of the glenoid of more than 15 % of the area was detected in 32 patients. Hill-Sachs grade 3 injury was reported in 24 patients. Most of these patients had a history of more than 20 dislocation episodes. Hyperelasticity of the shoulder joint was found in 34 patients. In the postoperative period, there was a slight improvement in the mean indicators of flexion and abduction in the shoulder joint from 174.2 ± 15.9° and 170.6 ± 17.8° to 175.6 ± 9.3° and 173.0 ± 12.3°, respectively. The mean external rotation worsened from 61.6 ± 25.7° to 55.9 ± 14.4°. Indicators of the ROWE, ASES, UCLA rating scales improved significantly from 38.5 ± 8.5, 76.0 ± 13.2 and 20.8 ± 3.0 to 89.9 ± 17.5, 94.0 ± 7.1 and 32.7 ± 3.7 points, respectively. Poor results were observed in 7 patients (4.1 %), of which three had a relapse.

Conclusions

Conclusions. Critically significant anatomical and functional disorders in patients with anterior instability of the shoulder joint are the defect of the anterior rim of the articular process of the scapula more than 15 %, the defect of the posterior surface of the humeral head (Hill-Sachs defect) of grade 3, hyperelasticity of the soft tissues of the shoulder joint. The severity of bone defects is directly proportional to the total number of dislocations. The effectiveness of surgical techniques for stabilizing the shoulder joint, depending on the above anatomical and functional disorders, was 95.9 %.

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The authors declare that there are no conflicts of interest present.