关节镜下 Bankart 修复术采用打结与无结缝线锚钉修复：有区别吗？
Arthroscopic Bankart repair using knot-tying versus knotless suture anchors: is there a difference?
机构信息
Department of Orthopaedic Surgery, National University of Singapore, National University Hospital, Singapore.
Department of Orthopaedic Surgery, National University of Singapore, National University Hospital, Singapore.
出版信息
Arthroscopy. 2014 Apr;30(4):422-7. doi: 10.1016/j.arthro.2014.01.005.
PURPOSE
To compare the clinical outcome between the use of knotless sutures versus knot-tying sutures in arthroscopic Bankart repairs.
METHODS
Between January 2007 and January 2011, 87 patients who underwent arthroscopic Bankart repair with the use of knot-tying suture anchors or knotless suture anchors were evaluated, with 45 patients in the knot-tying suture group and 42 patients in the knotless group. Patients were assigned to either group, with odd-numbered patients going to the knot-tying suture arm and even-numbered patients assigned to the knotless arm. Outcomes included the Constant score, the visual analog scale (VAS) score, patient satisfaction score, and range of motion in forward flexion and external rotation with the arm in adduction. Redislocations or subluxations with the 2 techniques was also studied.
RESULTS
Both groups showed a statistically significant improvement between the preoperative and postoperative VAS scores and Constant scores. In the knot-tying suture group, the VAS score improved from 2.5 ± 2.3 to 0.7 ± 0.5 (P < .05) and the Constant score improved from 64 ± 7 to 92 ± 10 (P < .05). In the knotless group, the VAS score improved from 2.8 ± 2.5 to 0.9 ± 0.6 (P < .05), and the Constant score improved from 62 ± 6 to 89 ± 9 (P < .05). The patient satisfaction scores were 6.9 and 7.1 for the knot tying and knotless groups, respectively. No statistically significant differences were found when comparing the outcomes between the 2 groups. The change in the range of forward flexion and external rotation was also similar in the 2 groups. There was also no difference in recurrence or redislocation rates.
CONCLUSIONS
Both the knot-tying and knotless suture anchors groups showed statistically significant and similar improvement in VAS and Constant scores. Both anchors provided reasonable outcomes. The knotless suture anchor is a good alternative to knot-tying suture anchors so that arthroscopic Bankart repairs can be performed without knot tying.
LEVEL OF EVIDENCE
Level II, prospective comparative study.
目的
比较无结缝线与打结缝线在关节镜 Bankart 修复术中的临床效果。
方法
2007 年 1 月至 2011 年 1 月，对 87 例接受关节镜 Bankart 修复术的患者进行了评估，其中 45 例患者使用打结缝线锚钉，42 例患者使用无结缝线锚钉。将患者分配到打结缝线组或无结缝线组，奇数号患者进入打结缝线组，偶数号患者进入无结缝线组。结果包括 Constant 评分、视觉模拟评分（VAS）、患者满意度评分以及肩关节前屈和外展时的活动范围。还研究了两种技术的再脱位或半脱位情况。
结果
两组患者的 VAS 评分和 Constant 评分在术前和术后均有统计学显著改善。在打结缝线组中，VAS 评分从 2.5±2.3 改善至 0.7±0.5（P<.05），Constant 评分从 64±7 改善至 92±10（P<.05）。在无结缝线组中，VAS 评分从 2.8±2.5 改善至 0.9±0.6（P<.05），Constant 评分从 62±6 改善至 89±9（P<.05）。打结缝线组和无结缝线组的患者满意度评分分别为 6.9 和 7.1。两组之间的结果比较无统计学显著差异。两组患者的前屈和外展活动范围的变化也相似。两种方法的再发或再脱位率也没有差异。
结论
打结缝线和无结缝线锚钉组的 VAS 和 Constant 评分均有统计学显著改善，且结果相似。两种锚钉均提供了合理的结果。无结缝线锚钉是替代打结缝线锚钉的良好选择，可使关节镜 Bankart 修复术无需打结。
证据等级
II 级，前瞻性比较研究。
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