Shymon Stephen J, Roocroft Joanna, Edmonds Eric W
*San Diego School of Medicine, University of California †Division of Orthopedic Surgery, Rady Children's Hospital San Diego, San Diego, CA.
J Pediatr Orthop. 2015 Jan;35(1):1-6. doi: 10.1097/BPO.0000000000000215.
Arthroscopic and open Bankart repairs have proven efficacy in adults with recurrent anterior shoulder instability. Although studies have included children in their analysis, none have previously compared functional outcomes or redislocation rates between these 2 methodologies for anteroinferior glenoid labrum repair in this young population. We hypothesize that open and arthroscopic Bankart repair in children will have similar functional outcomes and redislocation rates, but differing results from adults treated in a similar manner.
A retrospective chart review was performed on all Bankart repairs performed between 2006 and 2010 at a tertiary care children's hospital. A shift in treatment modalities occurred in 2008 creating 2 cohorts, open and arthroscopic. Brachial plexus injury, congenital soft-tissue disorder, or incomplete charts were excluded. Demographics, age at surgery, follow-up length, and sport were recorded. Telephone interviews were then performed obtaining the most current QuickDASH (Disability Arm, Shoulder, or Hand), WOSI (Western Ontario Shoulder Instability Index), SF-12 (Short Form 12), SANE (Single Assessment Numeric Evaluation), and verbal pain scores; as well as, inquiring about recurrent dislocation and further surgery.
Ninety-nine children (16.9±1.5 y) were included (28 open, 71 arthroscopic). There were no differences in preoperative demographics. Fifty-one patients completed the questionnaires (11 open, 40 arthroscopic). No significant differences in the outcomes scores were seen between the 2 groups. Of the 99 patients, 21 (21%) had redislocation or secondary surgery; there was no significant difference in failure rate between groups (4 open, 17 arthroscopic). A plotted survival curve demonstrated that the adolescent shoulder undergoing Bankart repair for recurrent traumatic anterior instability has a 2-year survival of 86% and a 5-year survival of only 49%, regardless of technique.
In adolescents, there is no significant difference in functional outcomes or redislocation rates between open and arthroscopic Bankart repair, yet both demonstrate a very high risk of failure in this young, athletic population which contrasts the results in the historic adult population.
Level III-retrospective comparative study.
关节镜下和开放性Bankart修复术已被证实在复发性前肩不稳的成人患者中具有疗效。尽管已有研究在分析中纳入了儿童，但此前尚无研究比较这两种方法在该年轻人群体中行肩胛下盂唇修复术的功能结局或再脱位率。我们假设儿童行开放性和关节镜下Bankart修复术将具有相似的功能结局和再脱位率，但与以类似方式治疗的成人结果不同。
对一家三级儿童专科医院在2006年至2010年期间进行的所有Bankart修复术进行回顾性病历审查。2008年治疗方式发生了转变，形成了两个队列，即开放性和关节镜下治疗。排除臂丛神经损伤、先天性软组织疾病或病历不完整的病例。记录人口统计学资料、手术年龄、随访时间和运动情况。随后进行电话访谈，获取最新的QuickDASH（上肢、肩部或手部功能障碍）、WOSI（西 Ontario 肩部不稳指数）、SF - 12（简短健康调查12项）、SANE（单项评估数字评价）和言语疼痛评分；以及询问复发性脱位和进一步手术情况。
纳入99名儿童（16.9±1.5岁）（28例开放性手术，71例关节镜手术）。术前人口统计学资料无差异。51例患者完成了问卷调查（11例开放性手术，40例关节镜手术）。两组之间的结局评分无显著差异。在99例患者中，21例（21%）发生再脱位或接受二次手术；两组之间的失败率无显著差异（4例开放性手术，17例关节镜手术）。绘制的生存曲线表明，因复发性创伤性前肩不稳接受Bankart修复术的青少年肩部，无论采用何种技术，2年生存率为86%，5年生存率仅为49%。
在青少年中，开放性和关节镜下Bankart修复术在功能结局或再脱位率方面无显著差异，但在这个年轻的运动人群中，两者均显示出非常高的失败风险，这与历史上成人人群的结果形成对比。
III级——回顾性比较研究。
