Magnusson Lennart, Ejerhed Lars, Rostgård-Christensen Lars, Sernert Ninni, Eriksson Rikard, Karlsson Jon, Kartus Jüri T
Department of Orthopaedics, Västerås Hospital, Västerås, Sweden.
Arthroscopy. 2006 Feb;22(2):143-51. doi: 10.1016/j.arthro.2005.12.016.
The aim of the study was to compare the clinical and radiographic results after arthroscopic Bankart reconstruction using 2 different types of absorbable implant.
Randomized controlled trial.
A randomized series of 40 patients who had recurrent, unidirectional, post-traumatic shoulder instability were included in the study. All patients underwent an arthroscopic Bankart reconstruction involving either polygluconate co-polymer (PGACP group, n = 20) or self-reinforced poly-L-lactic acid polymer (PLLA group, n = 20) tack implants. The patients underwent clinical and radiographic assessments preoperatively and at 2 years. Additional radiographic assessments were performed at 6 months.
Preoperatively, the study groups were comparable in terms of demographics as well as clinical parameters. One patient in each group had a redislocation (5%) during the follow-up period of 2 years. No subluxations were registered. No statistically significant differences were found between the study groups in terms of strength in abduction, range of motion, and Rowe or Constant scores. There was a significant increase in degenerative changes during the follow-up period in both study groups (P = .004). However, no significant differences in degenerative changes were registered between the study groups either preoperatively or at the 2-year follow-up. There were no significant differences in the radiographic visibility of the drill holes used for the absorbable implants between the study groups at the 6-month assessment. However, at the 2-year assessment, the radiographic visibility of the drill holes was significantly greater (P = .004) in the patients in the PLLA group than those in the PGACP group. At the 2-year assessment, no correlation was found between the appearance of the drill holes and the degenerative findings (PGACP group, rho = 0.44; PLLA group, rho = 0.42).
Two years after arthroscopic Bankart reconstruction using either PGA polymer or PLA polymer implants, the overall clinical results were comparable. Radiographic assessments revealed that the degenerative changes increased in both study groups during the follow-up period. Furthermore, the visibility of the drill holes on the 2-year radiographs was greater after using PLLA implants than after using PGACP implants.
Level I.
本研究旨在比较使用两种不同类型可吸收植入物进行关节镜下Bankart重建后的临床和影像学结果。
随机对照试验。
本研究纳入了40例复发性、单向性、创伤后肩关节不稳定的患者，将其随机分组。所有患者均接受了关节镜下Bankart重建，其中20例使用聚葡萄糖酸共聚物（PGACP组），另外20例使用自增强聚-L-乳酸聚合物（PLLA组）作为固定植入物。患者在术前及术后2年接受临床和影像学评估，术后6个月进行额外的影像学评估。
术前，两组患者在人口统计学和临床参数方面具有可比性。在2年的随访期内，每组各有1例患者出现再脱位（5%），未记录到半脱位情况。两组患者在外展力量、活动范围以及Rowe或Constant评分方面均未发现统计学上的显著差异。在随访期内，两组患者的退变改变均有显著增加（P = .004）。然而，术前及术后2年随访时，两组间的退变改变均无显著差异。在术后6个月的评估中，两组间用于可吸收植入物的钻孔在影像学上的可见度无显著差异。但在术后2年的评估中，PLLA组患者钻孔的影像学可见度显著高于PGACP组（P = .004）。在术后2年的评估中，未发现钻孔外观与退变表现之间存在相关性（PGACP组，rho = 0.44；PLLA组，rho = 0.42）。
使用PGA聚合物或PLA聚合物植入物进行关节镜下Bankart重建2年后，总体临床结果具有可比性。影像学评估显示，随访期间两组的退变改变均有所增加。此外，使用PLLA植入物后，术后2年X线片上钻孔的可见度高于使用PGACP植入物后。
I级。
