Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy.
Am J Sports Med. 2012 Nov;40(11):2462-9. doi: 10.1177/0363546512458572. Epub 2012 Sep 13.
An engaging Hill-Sachs lesion is a defect of the humeral head, large enough to cause locking of the humeral head against the anterior corner of the glenoid rim when the arm is at 90° of abduction and more than 30° of external rotation.
When Bankart lesions are associated with engaging Hill-Sachs defects, simultaneous Bankart repair and remplissage provide lower recurrence rates than does Bankart repair alone.
Cohort study; Level of evidence, 3.
Fifty patients (36 men, 14 women) with combined engaging Hill-Sachs and Bankart lesions were evaluated, before and after arthroscopic management, at a minimum follow-up of 2 years. After imaging and arthroscopic assessment, 25 patients underwent remplissage and Bankart repair, and 25 patients received Bankart repair alone. Patients were evaluated using the UCLA, Constant, and Rowe scores, and range of motion was measured using a goniometer. Postoperatively, all patients underwent magnetic resonance imaging to assess the status of healing of the anterior labrum and whether the tenodesis of the infraspinatus covered the Hill-Sachs defect.
At the last appointment, active forward elevation, external rotation beside the body, internal rotation, and all administered scores were significantly improved compared with baseline assessment, with no statistically significant intergroup differences. A new posttraumatic dislocation occurred in 5 patients, all from the Bankart-only group (20%).
Remplissage is a safe, relatively short procedure that allows the surgeon to address large humeral defects with a low postoperative recurrence rate. Humeral head large defects predispose to recurrent instability of the shoulder and deserve surgical management.
一个引人注目的 Hill-Sachs 损伤是肱骨头的缺陷，大到足以在手臂外展 90°和外旋超过 30°时导致肱骨头与肩胛盂前缘锁定。
当 Bankart 病变与 engaged Hill-Sachs 缺陷相关时，同时进行 Bankart 修复和 remplissage 比单独进行 Bankart 修复提供更低的复发率。
队列研究；证据水平，3 级。
对 50 例（36 名男性，14 名女性）合并 engaged Hill-Sachs 和 Bankart 病变的患者进行评估，在关节镜管理前后，至少随访 2 年。在影像学和关节镜评估后，25 例患者接受 remplissage 和 Bankart 修复，25 例患者仅接受 Bankart 修复。使用 UCLA、Constant 和 Rowe 评分对患者进行评估，并使用量角器测量活动范围。术后所有患者均行磁共振成像（MRI）检查，以评估前盂唇愈合情况以及肩胛下肌腱止点是否覆盖 Hill-Sachs 缺损。
末次随访时，与基线评估相比，主动前向抬高、体侧外旋、内旋和所有评分均显著改善，组间无统计学差异。5 例患者（均来自 Bankart 修复组）发生新的创伤后脱位（20%）。
Remplissage 是一种安全、相对较短的手术方法，可使外科医生用低术后复发率处理大的肱骨头缺陷。肱骨头大的缺陷容易导致肩关节反复不稳定，需要手术治疗。
