Brilakis Emmanouil, Mataragas Elias, Deligeorgis Anastasios, Maniatis Vasilios, Antonogiannakis Emmanouil
2nd Orthopaedic Department, Shoulder Arthroscopy and Surgery Center, IASO General Hospital, 44-46 Str. Sevastopoulou, 115 24, Athens, Greece.
Department of Radiology, IASO General Hospital, Athens, Greece.
Knee Surg Sports Traumatol Arthrosc. 2016 Feb;24(2):593-600. doi: 10.1007/s00167-014-2848-1. Epub 2014 Feb 1.
The purpose of the study was to present midterm results concerning the management of recurrent anterior shoulder instability with the remplissage technique in addition to the classic Bankart repair, in patients with engaging Hill-Sachs lesions.
During a time period of 4 years (January 2007-December 2010), 48 patients with an average age of 28.9 ± 7.8 years were operated on in our department. They all had a positive apprehension sign pre-operatively and satisfied the inclusion criteria of this study. Seventy-nine per cent of these patients were involved in sport activities of different levels. The mean follow-up period was 37.2 ± 9.9 months.
Three patients (6.3 %) had suffered a new dislocation: one of them after a low-energy trauma and the two other after a high-energy trauma. The rest of the patients (93.7 %) were satisfied with the surgical result and returned to their previous everyday activities while 70.8 % continued to participate in sporting activities without restrictions. The ASES score increased from 67.7 ± 21.5 points pre-operatively to 90.8 ± 21.7 points post-operatively (p < 0.01), the modified Rowe score from 38 ± 17.3 to 93.8 ± 14.5 (p < 0.001) and the Oxford Instability score from 27.6 ± 11.1 to 45.1 ± 8.3 (p < 0.001). No significant restriction in shoulder range of motion was documented.
The outcome of the enhancement of the classic Bankart repair with tenodesis of the infraspinatus and posterior capsular plication is very good as far as the management of recurrent anterior shoulder instability is concerned, without significantly influencing the range of motion of the shoulder.
Therapeutic study-case series with no comparison group, Level IV.
本研究的目的是呈现除经典Bankart修复术外，采用 remplissage 技术治疗伴有嵌顿性Hill-Sachs损伤的复发性前肩不稳的中期结果。
在4年时间（2007年1月至2010年12月）内，我科对48例平均年龄为28.9±7.8岁的患者进行了手术。他们术前均有阳性恐惧试验体征，且符合本研究的纳入标准。其中79%的患者参与不同水平的体育活动。平均随访时间为37.2±9.9个月。
3例患者（6.3%）发生了再次脱位：其中1例为低能量创伤后，另外2例为高能量创伤后。其余患者（93.7%）对手术结果满意，恢复了之前的日常活动，70.8%的患者继续无限制地参加体育活动。ASES评分从术前的67.7±21.5分提高到术后的90.8±21.7分（p<0.01），改良Rowe评分从38±17.3提高到93.8±14.5（p<0.001），牛津不稳评分从27.6±11.1提高到45.1±8.3（p<0.001）。未记录到肩部活动范围有明显受限。
就复发性前肩不稳的治疗而言，在经典Bankart修复术基础上增加冈下肌肌腱固定和后关节囊折叠的效果非常好，且对肩部活动范围无明显影响。
无对照组的治疗性病例系列，IV级。
