Instituto Argentino de Diagnóstico y Tratamiento, Marcelo T de Alvear 2400, Buenos Aires, Argentina.
Clin Orthop Relat Res. 2012 Apr;470(4):965-71. doi: 10.1007/s11999-011-2001-0.
Surgeons have traditionally treated recurrent shoulder dislocation by open methods. With the advent of arthroscopic repair techniques some surgeons reported higher recurrence rates than with open methods but some of those reports included patients with a variety of problems, including bone loss and those continuing in contact sports. It is unclear whether recurrence rates would be higher in patients without bone loss and those willing to forego contact sports.
QUESTIONS/PURPOSES: We therefore determined recurrence rates and functional scores after arthroscopic revision shoulder stabilization in patients without bone loss and those not subsequently participating in contact sports.
We retrospectively reviewed 16 patients who underwent a revision arthroscopic Bankart repair using suture anchors. An arthroscopic approach was selected in patients with a unilateral traumatic injury and mild to moderate bone loss. Arthroscopic stabilization was contraindicated in patients with (1) multidirectional shoulder instability; (2) greater than 25% glenoid bone loss; (3) a Hill Sachs lesion involving more than one-third of the articular surface of the humeral head; and (4) patients electing to continue pursuing contact sports. At followup, physical examination of both shoulders was conducted. Several functional scores (Rowe, UCLA, and Constant & Murley) were compiled. The minimum followup was 24 months (mean, 31 months; range, 24-46 months).
The UCLA score (22-31), Constant & Murley score (69-80), and Rowe score (33-80) all improved. Shoulder instability recurred in three of the 16 patients, two sustaining dislocations and one a subluxation. One recurrence was the result of new trauma and this patient underwent an open Latarjet procedure; the other two patients refused further surgery.
Revision arthroscopic Bankart repair using suture anchors was associated with a low recurrence rate and restoration of acceptable function in patients without bone loss and not participating in contact sports.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
传统上，外科医生通过开放式手术治疗复发性肩关节脱位。随着关节镜修复技术的出现，一些外科医生报告说，这种方法的复发率高于开放式手术，但其中一些报告包括了各种问题的患者，包括骨量丢失和继续从事接触性运动的患者。目前尚不清楚在没有骨量丢失且不参加接触性运动的患者中，复发率是否会更高。
问题/目的：因此，我们确定了在没有骨量丢失且不随后参加接触性运动的患者中，进行关节镜下复发性肩关节稳定修复后的复发率和功能评分。
我们回顾性分析了 16 例接受关节镜下 Bankart 修复术（使用缝线锚钉）的患者。在单侧创伤性损伤和轻度至中度骨量丢失的患者中，选择关节镜入路。如果存在以下情况，则不建议进行关节镜下稳定术：（1）多向性肩关节不稳定；（2）>25%的关节盂骨丢失；（3）Hill Sachs 病变累及肱骨头关节面的三分之一以上；（4）患者选择继续从事接触性运动。随访时，对双侧肩部进行体格检查。收集了几种功能评分（Rowe、UCLA 和 Constant&Murley）。最短随访时间为 24 个月（平均 31 个月；范围 24-46 个月）。
UCLA 评分（22-31）、Constant&Murley 评分（69-80）和 Rowe 评分（33-80）均有所改善。16 例患者中有 3 例复发，2 例发生脱位，1 例发生半脱位。1 例复发是新创伤的结果，该患者接受了开放式 Latarjet 手术；另外 2 例患者拒绝进一步手术。
对于没有骨量丢失且不参加接触性运动的患者，使用缝线锚钉的关节镜下 Bankart 修复术与低复发率和可接受的功能恢复相关。
IV 级，治疗性研究。有关证据水平的完整描述，请参见作者指南。
