Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.
Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A.
Arthroscopy. 2014 Apr;30(4):444-50. doi: 10.1016/j.arthro.2013.12.015.
This study aims to evaluate our outcomes of arthroscopic remplissage in this setting.
A retrospective review was performed to identify patients who underwent arthroscopic remplissage of an engaging Hill-Sachs lesion along with anterior capsulolabral reconstruction for anterior glenohumeral instability with moderate glenohumeral bone loss at our institution. Thirty-five patients, with a minimum of 2 years' follow-up, were identified. We assessed the American Shoulder and Elbow Surgeons score, incidence of recurrent instability, and postoperative Rowe instability score.
Follow-up was available for 30 patients (31 shoulders). The mean age was 24.6 years, with a mean follow-up period of 41 months. Prior instability surgery had failed in 11 patients, and they underwent capsulolabral reconstruction and remplissage ("revision surgery"). The failure rate in revision cases (36%) was significantly higher than the failure rate in primary surgery cases (0%) (P = .01). Failure resulted from trauma in all 4 patients, and none required further surgery. The mean American Shoulder and Elbow Surgeons score for all patients improved from 50 preoperatively to 91 postoperatively (P < .001), with no significant postoperative difference between primary and revision patients (P = .13). The patients with clinical failure showed nonsignificant improvement from 41 preoperatively to 72 postoperatively (P = .08). The mean postoperative Rowe score for the entire cohort was 90. The Rowe score was significantly lower in the 4 cases of failure than in the 27 non-failure cases (51 v 96, P < .001).
In our experience, aggressive capsulolabral reconstruction with remplissage in traumatic instability patients with moderate bone loss and engaging humeral Hill-Sachs lesions yields acceptable outcomes for primary instability surgery. However, a significantly higher failure rate occurred when arthroscopic reconstruction with remplissage was performed in the revision setting.
Level IV, therapeutic case series.
本研究旨在评估我们在这种情况下进行关节镜下填充术的结果。
对在我院行关节镜下填充术治疗伴前关节囊盂唇复合体撕裂的前肩盂肱不稳合并中量肩盂骨缺损的患者进行回顾性研究。共纳入 35 例患者，随访时间至少 2 年。评估美国肩肘外科医生评分、复发性不稳定的发生率和术后 Rowe 不稳定评分。
30 例（31 肩）患者获得随访。平均年龄 24.6 岁，平均随访时间 41 个月。11 例患者既往不稳定手术失败，行关节囊盂唇复合体重建和填充术（“翻修手术”）。翻修病例的失败率（36%）明显高于初次手术病例（0%）（P =.01）。所有 4 例翻修失败患者均因创伤导致失败，均未再次手术。所有患者的美国肩肘外科医生评分均从术前的 50 分提高到术后的 91 分（P <.001），初次手术和翻修手术患者之间术后无显著差异（P =.13）。临床失败的患者从术前的 41 分提高到术后的 72 分（P =.08），但无显著改善。整个队列的平均术后 Rowe 评分为 90 分。4 例失败病例的 Rowe 评分明显低于 27 例非失败病例（51 分比 96 分，P <.001）。
在我们的经验中，对于合并中量肩盂骨缺损和肩盂肱“ engages Hill-Sachs”损伤的创伤性不稳定患者，采用关节镜下盂唇复合体重建和填充术治疗初次肩盂肱不稳可获得满意的结果。然而，在翻修手术中采用关节镜下重建和填充术时，失败率显著升高。
IV 级，治疗性病例系列。
