Jiang Chun-Yan, Zhu Yi-Ming, Liu Xin, Li Feng-Long, Lu Yi, Wu Guan
Yi-Ming Zhu, Sports Medicine Department, Beijing Ji Shui Tan Hospital, Peking University School of Medicine, No. 31 Xin Jie Kou Dong Jie, 100035 Beijing, China.
Am J Sports Med. 2013 Nov;41(11):2617-23. doi: 10.1177/0363546513499304. Epub 2013 Aug 20.
Bony Bankart lesions can be treated with arthroscopic repair. However, few studies have evaluated the importance of bony fragment reduction and healing to stability of the glenohumeral joint after arthroscopic bony Bankart repair.
To evaluate functional results after surgery and determine the correlation between reduction and healing of the fracture and postoperative stability of the glenohumeral joint.
Case series; Level of evidence, 4.
A total of 50 patients (47 men, 3 women; average age, 27.6 years; range, 16.5-50.1 years) with bony Bankart lesions and recurrent anterior shoulder dislocations were treated with arthroscopic reduction and internal fixation with suture anchors. The average follow-up period was 32.5 months (range, 24.3-61.2 months). Preoperative and postoperative range of motion and American Shoulder and Elbow Surgeons (ASES), Constant-Murley, and Rowe scores were compared to evaluate the results of the surgeries. Sequential 3-dimensional computed tomography (CT) scans were available for 37 patients and were analyzed to investigate the effect of the bony defect of the glenoid and the correlation between the success of the surgery and reduction and healing of the bony fragment.
After surgery, active forward elevation was significantly improved (P < .05). No significant differences were found regarding external and internal rotations after surgery. The ASES, Constant-Murley, and Rowe scores improved significantly after surgery. Redislocations occurred in 3 patients, and a positive anterior apprehension sign was detected in 1 patient during follow-up. The overall failure rate was 8.0% (4/50). The CT scans during the follow-up period showed a nonunion of the bony fragment in 13.5% of cases (5/37). The reconstructed size of the glenoid was <80% in 3 of the 4 failure cases but >80% in all of the successful cases.
Arthroscopic reduction and fixation of a bony Bankart lesion can achieve good results in selected cases. The size of the reconstructed glenoid is crucial to the success of the surgery.
骨性Bankart损伤可通过关节镜修复进行治疗。然而，很少有研究评估关节镜下骨性Bankart修复术后，骨块复位及愈合对盂肱关节稳定性的重要性。
评估手术的功能结果，并确定骨折复位与愈合和盂肱关节术后稳定性之间的相关性。
病例系列；证据等级，4级。
共有50例（47例男性，3例女性；平均年龄27.6岁；范围16.5 - 50.1岁）患有骨性Bankart损伤和复发性肩关节前脱位的患者接受了关节镜下复位并用缝线锚钉进行内固定治疗。平均随访期为32.5个月（范围24.3 - 61.2个月）。比较术前和术后的活动范围以及美国肩肘外科医师协会（ASES）、Constant - Murley和Rowe评分，以评估手术结果。37例患者有连续的三维计算机断层扫描（CT）图像，对其进行分析以研究肩胛盂骨缺损的影响以及手术成功与骨块复位和愈合之间的相关性。
术后，主动前举明显改善（P <.05）。术后外旋和内旋未发现显著差异。术后ASES、Constant - Murley和Rowe评分显著改善。随访期间有3例患者发生再脱位，1例患者检测到阳性前恐惧征。总体失败率为8.0%（4/50）。随访期间的CT扫描显示13.5%的病例（5/37）骨块未愈合。4例失败病例中有3例的肩胛盂重建尺寸<80%，而所有成功病例的重建尺寸均>80%。
关节镜下复位并固定骨性Bankart损伤在特定病例中可取得良好效果。肩胛盂重建的尺寸对手术成功至关重要。
