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关节镜下稳定术联合热缩术治疗伴有或不伴有Bankart损伤的前交叉韧带损伤:康复与固定的作用

Arthroscopic stabilization plus thermal capsulorrhaphy for anterior instability with and without Bankart lesions: the role of rehabilitation and immobilization.

作者信息

Hawkins R J, Karas S G

机构信息

Steadman Hawkins Clinic, Vail, Colorado, USA.

出版信息

Instr Course Lect. 2001;50:13-5.

Abstract

The use of thermal energy is an exciting new technology in the treatment of anterior instability with and without Bankart reconstruction. The current approach for treating anterior instability in the absence of a Bankart lesion as discussed here is to perform thermal capsular shrinkage with a monopolar RF heat probe to address laxity in the anterior capsule and the inferior glenohumeral ligaments. If a Bankart lesion is present, repair of the lesion with arthroscopic suture anchors followed by thermal capsulorrhaphy is our treatment of choice. We currently reserve open anterior reconstruction for patients with pathology inappropriate for arthroscopic techniques and in cases where arthroscopic suturing is found to be inadequate intraoperatively. Furthermore, patients who require revision and athletes who engage in contact sports are evaluated on an individual basis to ascertain if arthroscopic techniques are appropriate (CD-2.1). Nonetheless, basic science research has revealed the importance of a formal period of immobilization followed by guarded mobilization. By using the aforementioned algorithm and postoperative protocol, low recurrence rates have been achieved while at the same time maintaining motion in the functional range. Of course, further follow-up, more patient studies, and peer review publications are required to determine if thermal capsulorrhaphy can replace open procedures as the gold standard for addressing capsular laxity associated with anterior instability.

摘要

在伴有或不伴有Bankart重建的前向不稳治疗中,热能的应用是一项令人兴奋的新技术。本文所讨论的在无Bankart损伤情况下治疗前向不稳的当前方法是,使用单极射频热探头进行热囊膜皱缩,以解决前囊膜和下盂肱韧带的松弛问题。如果存在Bankart损伤,我们的首选治疗方法是用关节镜缝线锚钉修复损伤,然后进行热囊膜缝合术。目前,对于那些病理情况不适合关节镜技术的患者以及术中发现关节镜缝合不充分的病例,我们保留开放前路重建手术。此外,对于需要翻修的患者以及从事接触性运动的运动员,会进行个体化评估,以确定关节镜技术是否合适(CD - 2.1)。尽管如此,基础科学研究已经揭示了进行一段正式固定期后再进行保护性活动的重要性。通过使用上述算法和术后方案,在保持功能范围内活动的同时,实现了低复发率。当然,还需要进一步的随访、更多的患者研究以及同行评审出版物,以确定热囊膜缝合术是否能够取代开放手术,成为解决与前向不稳相关的囊膜松弛的金标准。

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