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关节镜下 Bankart 修复术治疗肩关节前向不稳定后肱骨头-肩盂关节炎。

Glenohumeral osteoarthritis after arthroscopic Bankart repair for anterior instability.

机构信息

Department of Orthopaedic and Trauma Surgery, the University Campus Bio-Medico of Rome, Rome, Italy.

出版信息

Am J Sports Med. 2011 Aug;39(8):1653-9. doi: 10.1177/0363546511404207. Epub 2011 May 4.

DOI:10.1177/0363546511404207
PMID:21543624
Abstract

BACKGROUND

Few data on shoulder arthropathy in patients undergoing arthroscopic repair for glenohumeral instability are available.

HYPOTHESIS

Arthroscopic stabilization of Bankart lesions does not prevent the development of postoperative glenohumeral osteoarthritis.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Clinical (Rowe and Constant scores) and radiographic preoperative and postoperative data from 60 patients who underwent arthroscopic Bankart repair were compared. Osteoarthritis was graded preoperatively and postoperatively with the Buscayret classification grading system. The average age at surgery was 27.6 years, and follow-up averaged 8.0 years.

RESULTS

The postoperative incidence of osteoarthritis in patients with no preoperative degenerative changes was 21.8% (12 of 55 patients). The incidence of degenerative joint disease of the glenohumeral joint showed evidence of a statistically significant association with older age at first dislocation and at surgery, increased length of time from the first episode to surgery, increased number of preoperative dislocations, increased length of time from the initial dislocation until surgery, increased number of anchors used at surgery, and more degenerated labrum at surgery. A higher number of preoperative dislocations, a greater length of follow-up, and reduced external rotation in abduction influenced Rowe and Constant scores.

CONCLUSION

The number of anchors used and the state of the labrum are the most important factors associated with a higher risk of radiographic degenerative changes. Longer follow-up investigations are needed to draw meaningful conclusions.

摘要

背景

有关接受关节镜下盂肱不稳修复术患者的肩部关节炎的数据较少。

假设

关节镜下 Bankart 修复术不能预防术后肩关节炎的发生。

研究设计

病例系列;证据等级,4 级。

方法

对 60 例接受关节镜 Bankart 修复术的患者的临床(Rowe 和 Constant 评分)和术前、术后影像学资料进行比较。术前和术后采用 Buscayret 分类分级系统对关节炎进行分级。手术平均年龄为 27.6 岁,平均随访 8.0 年。

结果

术前无退行性改变的患者术后骨关节炎的发生率为 21.8%(55 例中有 12 例)。退行性关节病的发病与初次脱位和手术时的年龄较大、从首次发作到手术的时间延长、术前脱位次数增加、从最初脱位到手术的时间延长、手术中使用的锚钉数量增加以及手术中半月板退变有关。术前脱位次数较多、随访时间较长、外展时外旋减少均影响 Rowe 和 Constant 评分。

结论

使用的锚钉数量和半月板的状态是与放射学退行性改变风险增加相关的最重要因素。需要进行更长时间的随访研究以得出有意义的结论。

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