Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet, University of Nice, Nice, France.
Clin Orthop Relat Res. 2012 Sep;470(9):2554-60. doi: 10.1007/s11999-012-2296-5. Epub 2012 Mar 1.
Neer modified the Bankart procedure by combining a superoinferior capsular shift with the labral reattachment. The theoretical advantages of the modification were that such a procedure would restore the patient's anatomy and also treat the repeated capsular stretching encountered in anteroinferior instability without limiting external rotation and, thereby reducing the risk of arthritis.
QUESTIONS/PURPOSES: We therefore determined: (1) the rate of recurrent instability after this modification, (2) patient function, and (3) the incidence and stage of glenohumeral osteoarthritis at greater than 2 years followup in patients with traumatic anteroinferior instability.
We retrospectively reviewed all 64 patients (average age, 27 years) who had the modified Bankart procedure for recurrent dislocations (n = 39) or subluxation (n = 25) from 1991 to 1997. The labrum was reattached with suture anchors and a superoinferior capsular shift was added. We determined the rate of recurrent instability, Rowe and Walch-Duplay scores and shoulder ROM, and the presence of glenohumeral osteoarthritis (modified Samilson and Prieto classification). The minimum followup was 24 months (median, 40 months; range, 24-120 months).
Recurrent instability occurred in seven of the 64 patients (11%) at an average of 25 months postoperatively (range, 7 days to 6 years); in six patients the recurrence was associated with trauma; five of the six patients underwent reoperation with a Latarjet procedure. Eight additional patients (13%) presented with persistent shoulder apprehension or discomfort. The average Rowe score was 83% (range, 20-100%) and average Walch-Duplay score 83% (range, 15-100%). However, only 36 of 64 (56%) patients could return to the same sport at the same level. The loss of external rotation was 13° compared with the contralateral side. Glenohumeral osteoarthritis incidence increased from 4% preoperatively to 17% postoperatively.
The open Bankart procedure modified by Neer provided high function scores but a relatively low rate of return to sport and high rate of recurrent instability. Our rate of recurrent instability, similar to that obtained with arthroscopic Bankart procedures, has prompted us to abandon the open procedure.
Neer 通过将上下囊层移位与盂唇再附着结合起来，对 Bankart 手术进行了改良。改良的理论优势在于，这样的手术不仅可以恢复患者的解剖结构，还可以治疗前下不稳定中反复发生的囊层拉伸，而不会限制外旋，从而降低关节炎的风险。
问题/目的：因此，我们确定：（1）改良手术后复发性不稳定的发生率；（2）患者功能；（3）创伤性前下不稳定患者大于 2 年随访时的肩盂肱关节炎发生率和分期。
我们回顾性分析了 1991 年至 1997 年期间因复发性脱位（n = 39）或半脱位（n = 25）接受改良 Bankart 手术的 64 例患者（平均年龄 27 岁）的所有病例。盂唇用缝线锚钉重新附着，并进行上下囊层移位。我们确定了复发性不稳定的发生率、Rowe 和 Walch-Duplay 评分以及肩部活动范围，以及肩盂肱关节炎的存在（改良 Samilson 和 Prieto 分类）。最低随访时间为 24 个月（中位数 40 个月；范围 24-120 个月）。
64 例患者中有 7 例（11%）在术后平均 25 个月（范围 7 天至 6 年）时出现复发性不稳定；6 例患者复发与创伤有关；6 例患者中有 5 例接受了 Latarjet 手术。另外 8 例（13%）患者出现持续性肩部紧张或不适。平均 Rowe 评分为 83%（范围 20-100%），平均 Walch-Duplay 评分为 83%（范围 15-100%）。然而，只有 64 例患者中的 36 例（56%）能够回到相同水平的相同运动中。与对侧相比，外旋丧失 13°。肩盂肱关节炎的发生率从术前的 4%增加到术后的 17%。
Neer 改良的开放式 Bankart 手术提供了较高的功能评分，但运动恢复率相对较低，复发性不稳定率较高。我们的复发性不稳定率与关节镜 Bankart 手术相似，这促使我们放弃了开放式手术。
