Creighton R Alexander, Romeo Anthony A, Brown Fredrick M, Hayden Jennifer K, Verma Nikhil N
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA.
Arthroscopy. 2007 Jul;23(7):703-9. doi: 10.1016/j.arthro.2007.01.021.
The purpose of this study was to report on a difficult patient population and to critically evaluate the role of revision arthroscopic stabilization surgery.
Eighteen patients with failed traumatic instability repairs were treated with revision arthroscopic labral fixation and plication with a mean follow-up of 29.7 months (range, 24 to 48 months). There were 15 male patients and 3 female patients with a mean age of 28.6 years (range, 15 to 50 years). Of the 18 patients, 9 were Workers' Compensation cases. The 18 patients had a mean of 1.55 surgeries before our revision surgery, with 9 having a component of thermocapsular shrinkage. The patients' characteristics, operative techniques, and findings were recorded, and their clinical outcome was critically evaluated (via physical examination, visual analog pain scale, Simple Shoulder Test, American Shoulder and Elbow Surgeons score, and Short Form 12).
The revision surgery incorporated a 4-portal technique via a mean of 4.6 suture anchors and 3 plication stitches, and 15 patients received a rotator interval closure. At the follow-up evaluation, 13 patients had satisfactory results whereas 5 cases were considered clinical failures (with recurrent instability in 3 and pain in 2). There was clinically significant improvement in pain score (6 preoperatively v 2 postoperatively, P = .0001), Simple Shoulder Test score (6 preoperatively v 10 postoperatively, P = .001), and American Shoulder and Elbow Surgeons score (50 preoperatively v 76 postoperatively, P = .001). Of the 9 Workers' Compensation patients, 5 were able to return to their original work.
Arthroscopic revision instability repair by use of a combination of suture anchors, plication stitches, and rotator interval closure can result in a satisfactory outcome in selected patients.
Level IV, therapeutic case series.
本研究旨在报告一类复杂的患者群体，并对关节镜下翻修稳定手术的作用进行严格评估。
18例创伤性不稳定修复失败的患者接受了关节镜下盂唇翻修固定和折叠术，平均随访29.7个月（范围24至48个月）。其中男性患者15例，女性患者3例，平均年龄28.6岁（范围15至50岁）。18例患者中，9例为工伤赔偿病例。这18例患者在我们进行翻修手术前平均接受过1.55次手术，其中9例存在热囊收缩成分。记录患者的特征、手术技术和发现，并对其临床结果进行严格评估（通过体格检查、视觉模拟疼痛量表、简单肩部试验、美国肩肘外科医师评分和简明健康调查问卷12）。
翻修手术采用4通道技术，平均使用4.6个缝合锚钉和3针折叠缝合，15例患者进行了旋转间隙闭合。在随访评估中，13例患者结果满意，5例被认为是临床失败（3例复发性不稳定，2例疼痛）。疼痛评分（术前6分对术后2分，P = 0.0001）、简单肩部试验评分（术前6分对术后10分，P = 0.001）和美国肩肘外科医师评分（术前50分对术后76分，P = 0.0）有显著临床改善。9例工伤赔偿患者中，5例能够重返原工作岗位。
通过联合使用缝合锚钉、折叠缝合和旋转间隙闭合进行关节镜下翻修不稳定修复，可使部分患者获得满意结果。
IV级，治疗性病例系列。
