术前脱位次数增加以及脱位总时长会影响前肩不稳的手术治疗。
Increasing preoperative dislocations and total time of dislocation affect surgical management of anterior shoulder instability.
作者信息
Denard Patrick J, Dai Xuesong, Burkhart Stephen S
机构信息
Southern Oregon Orthopedics, Medford, Portland, Oregon, USA ; Department of Orthopedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon, USA.
The San Antonio Orthopedic Group, San Antonio, Texas, USA.
出版信息
Int J Shoulder Surg. 2015 Jan-Mar;9(1):1-5. doi: 10.4103/0973-6042.150215.
PURPOSE
Our purpose was to determine the relationship between number of preoperative shoulder dislocations and total dislocation time and the need to perform bone deficiency procedures at the time of primary anterior instability surgery. Our hypothesis was that need for bone deficiency procedures would increase with the total number and hours of dislocation.
MATERIALS AND METHODS
A retrospective review was performed of primary instability surgeries performed by a single surgeon. Patients with <25% glenoid bone loss were treated with an isolated arthroscopic Bankart repair. Those who also had an engaging Hill-Sachs lesion underwent arthroscopic Bankart repair with remplissage. Patients with >25% glenoid bone loss were treated with Latarjet reconstruction. Number of dislocations and total dislocation time were examined for their relationship with the treatment method.
RESULTS
Ten arthroscopic Bankart repairs, 13 arthroscopic Bankart plus remplissage procedures, and 9 Latarjet reconstructions were available for review. Total dislocations (P = 0.012) and total hours of dislocation (P = 0.019) increased from the Bankart, to the remplissage, to the Latarjet groups. Patients with a total dislocation time of 5 h or more were more likely to require a Latarjet reconstruction (P = 0.039). Patients with only 1 preoperative dislocation were treated with an isolated Bankart repair in 64% (7 of 11) of cases, whereas those with 2 or more dislocations required a bone loss procedure in 86% (18 of 21) of cases (P = 0.013).
CONCLUSION
Increasing number of dislocations and total dislocation time are associated with the development of glenoid and humeral head bony lesions that alter surgical management of anterior shoulder instability. The necessity for the addition of a remplissage to an arthroscopic Bankart repair or the use of a Latarjet reconstruction increases with only 1 recurrent dislocation.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
目的
我们的目的是确定术前肩关节脱位次数和总脱位时间与初次前向不稳定手术时进行骨缺损手术必要性之间的关系。我们的假设是，骨缺损手术的必要性会随着脱位总数和脱位时长的增加而增加。
材料与方法
对由一名外科医生实施的初次不稳定手术进行回顾性研究。关节盂骨丢失<25%的患者接受单纯关节镜下Bankart修复术。那些同时伴有嵌顿性Hill-Sachs损伤的患者接受关节镜下Bankart修复术并加做 remplissage 手术。关节盂骨丢失>25%的患者接受Latarjet重建术。研究脱位次数和总脱位时间与治疗方法之间的关系。
结果
可供分析的有10例关节镜下Bankart修复术、13例关节镜下Bankart修复术加做remplissage手术以及9例Latarjet重建术。从Bankart修复术组到remplissage手术组再到Latarjet重建术组，脱位总数（P = 0.012）和总脱位时长（P = 0.019）均呈上升趋势。总脱位时间达5小时或更长时间的患者更有可能需要进行Latarjet重建术（P = 0.039）。仅术前有1次脱位的患者，64%（11例中的7例）接受单纯Bankart修复术，而有2次或更多次脱位的患者，86%（21例中的18例）需要进行骨丢失手术（P = 0.013）。
结论
脱位次数增加和总脱位时间延长与关节盂和肱骨头骨病变的发生相关，这些病变会改变前肩关节不稳定的手术治疗方式。仅1次复发性脱位就会增加在关节镜下Bankart修复术基础上加做remplissage手术或采用Latarjet重建术的必要性。
证据级别
三级，回顾性比较研究。
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