Kim Seung-Ho, Ha Kwon-Ick, Cho Yang-Bum, Ryu Byung-Dam, Oh Irvin
Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
J Bone Joint Surg Am. 2003 Aug;85(8):1511-8.
The purpose of this study was to evaluate prospectively the surgical outcomes of arthroscopic repair of anterior capsulolabral lesions with use of suture anchors in a large series of patients who were followed for two to six years.
We evaluated the results of arthroscopic Bankart repair with use of suture anchors and nonabsorbable sutures in 167 patients with traumatic recurrent anterior instability of the shoulder. The mean age at the time of the operation was twenty-five years. Preoperatively and at the time of follow-up (at a mean of forty-four months), the patients were assessed with three objective outcome measurement tools (the Rowe score, the University of California at Los Angeles [UCLA] shoulder rating scale, and the American Shoulder and Elbow Surgeons [ASES] score) and two subjective measurement tools (pain and function visual analog scales). The recurrence rate, range of motion, and risk factors for postoperative recurrence were evaluated.
All shoulder scores improved after surgery (p < 0.001). According to the Rowe scale, 130 patients (78%) had an excellent score; twenty-nine (17%), a good score; six (4%), a fair score; and two (1%), a poor score. Overall, the rate of postoperative recurrence of instability was 4% (one dislocation, two subluxations, and four positive results on the anterior apprehension test). Postoperative recurrence was related to an osseous defect of >30% of the entire glenoid circumference. In the patients with recurrent postoperative instability, the episodes were less frequent than they had been preoperatively and shoulder function was related to activity level. A revision arthroscopic Bankart repair stabilized three of the four shoulders in which it was performed. One hundred and fifty-two patients (91%) returned to >/=90% of their preinjury activity level. The mean loss of external rotation (and standard deviation) was 2.0 degrees +/- 4.0 degrees.
We found that, in contrast to previous reports on the results of arthroscopic repair, arthroscopic capsulolabral repair with use of suture anchors can provide satisfactory outcomes in terms of recurrence rate, activity, and range of motion.
本研究的目的是前瞻性评估在一大组随访2至6年的患者中，使用缝合锚钉进行关节镜下修复前关节囊盂唇损伤的手术效果。
我们评估了167例创伤性复发性肩关节前不稳定患者使用缝合锚钉和不可吸收缝线进行关节镜下Bankart修复的结果。手术时的平均年龄为25岁。术前及随访时（平均44个月），使用三种客观结果测量工具（Rowe评分、加利福尼亚大学洛杉矶分校[UCLA]肩关节评分量表和美国肩肘外科医师学会[ASES]评分）和两种主观测量工具（疼痛和功能视觉模拟量表）对患者进行评估。评估复发率、活动范围和术后复发的危险因素。
术后所有肩关节评分均有改善（p < 0.001）。根据Rowe量表，130例患者（78%）评分优秀；29例（17%）评分良好；6例（4%）评分中等；2例（1%）评分差。总体而言，不稳定术后复发率为4%（1例脱位、2例半脱位和4例前恐惧试验阳性结果）。术后复发与整个肩胛盂圆周>30%的骨缺损有关。在术后复发性不稳定的患者中，发作频率低于术前，且肩关节功能与活动水平有关。在进行翻修关节镜下Bankart修复的4例肩关节中，3例得到稳定。152例患者（91%）恢复到受伤前活动水平的>/=90%。外旋平均损失（及标准差）为2.0度+/-4.0度。
我们发现，与先前关于关节镜修复结果的报告相反，使用缝合锚钉进行关节镜下关节囊盂唇修复在复发率、活动和活动范围方面可提供满意的结果。
