John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, US Military Academy, West Point, New York, USA.
University of Connecticut, Farmington, Connecticut, USA.
Orthop J Sports Med. 2015 Jan 23;3(1):2325967115571084. doi: 10.1177/2325967115571084. eCollection 2015 Jan.
Most of the literature on shoulder instability focuses on patients experiencing anterior glenohumeral dislocation, with little known about the treatment of anterior subluxation events.
To determine the outcomes of surgical stabilization of patients with anterior glenohumeral subluxations and to compare open and arthroscopic approaches.
Randomized controlled trial; Level of evidence, 2.
We prospectively enrolled patients with anterior glenohumeral subluxations undergoing surgical stabilization. Patients were offered randomization between open and arthroscopic stabilization. Inclusion criteria included patients with anterior glenohumeral subluxations undergoing Bankart repair, while exclusions included the presence of glenoid or humeral bone loss, multidirectional instability, capsular tear/humeral avulsion of the glenohumeral ligament lesion, and rotator cuff tear requiring repair. Patients were randomized to an open Bankart repair through a subscapularis takedown or an arthroscopic Bankart repair, both using the same bioabsorbable suture anchors, and they were followed for a minimum of 2 years. Outcomes were evaluated with the Single Assessment Numeric Evaluation (SANE), Western Ontario Shoulder Instability Index (WOSI), American Shoulder and Elbow Surgeons Score (ASES), Simple Shoulder Test (SST), Rowe, and Tegner activity scores.
A total of 26 patients were enrolled, with 7 being lost to follow-up. Complete follow-up data were available on 19 subjects (74%): 10 in the open group and 9 in the arthroscopic group. There were no significant differences noted between the randomized groups, with a 2-year WOSI score of 320 in the open subjects and 330 in the arthroscopic subjects, and similar findings in the other scoring scales. There were no cases of dislocation following surgery. There were 3 patients with recurrent instability (subluxations only) in each group at a mean of 17 months, for an overall recurrent subluxation rate of 31%. These subjects with recurrence had lower outcome scores (WOSI, 532; SANE, 88.4). The outcomes of the 9 subjects with ≤3 subluxation events were superior to those of the 10 subjects with >3 events prior to stabilization. The patients with ≤3 events had a WOSI score of 143, compared with 470 (P = .042), and an ASES mean score of 98.8, compared with 87.1 (P = .048). Four of the 6 patients with recurrent subluxations had sustained >3 subluxations prior to stabilization.
Overall, patients with Bankart lesions resulting from an anterior glenohumeral subluxation event had excellent outcomes with surgical stabilization. The overall recurrence in the 19 subjects with at least 2-year follow-up was 6 cases (31%), with no instances of dislocation in this young, active cohort. There was no significant benefit to open or arthroscopic stabilization, and we did find that stabilization of subluxation patients with ≤3 events resulted in superior outcomes compared with chronic recurrent subluxation patients with >3 events. We recommend early surgical stabilization of young athletes with Bankart lesions that result from anterior subluxation events.
大多数关于肩关节不稳定的文献都集中在前肩盂肱关节脱位的患者上，而对于前盂唇下脱位事件的治疗知之甚少。
确定手术治疗前盂唇下脱位患者的结果，并比较开放和关节镜入路。
随机对照试验；证据水平，2。
我们前瞻性地招募了接受前肩盂唇下脱位手术稳定治疗的患者。患者可选择接受开放或关节镜稳定治疗。纳入标准包括前肩盂唇下脱位接受 Bankart 修复的患者，而排除标准包括盂肱骨缺损、多向不稳定、关节囊撕裂/盂肱上韧带损伤、肩袖撕裂需要修复。患者随机分为开放 Bankart 修复组（通过肩胛下肌切开）或关节镜 Bankart 修复组，均使用相同的可吸收缝线锚钉，并至少随访 2 年。使用单一评估数字评估（SANE）、西部安大略省肩不稳定指数（WOSI）、美国肩肘外科医生评分（ASES）、简单肩测试（SST）、Rowe 和 Tegner 活动评分来评估结果。
共纳入 26 例患者，其中 7 例失访。19 例（74%）患者获得完整随访数据：开放组 10 例，关节镜组 9 例。随机分组之间无显著差异，开放组 2 年 WOSI 评分为 320，关节镜组为 330，其他评分量表也有类似发现。术后无脱位病例。每组各有 3 例（共 6 例）患者出现复发性不稳定（仅半脱位），平均发生在 17 个月时，总体复发性半脱位率为 31%。这些复发性不稳定的患者的结果评分较低（WOSI，532；SANE，88.4）。复发性不稳定患者中，半脱位事件发生次数≤3 次的 9 例患者的结局优于术前稳定时半脱位事件发生次数>3 次的 10 例患者。半脱位事件发生次数≤3 次的患者的 WOSI 评分为 143，而>3 次的患者为 470（P=.042），ASES 平均评分为 98.8，而>3 次的患者为 87.1（P=.048）。在 6 例复发性半脱位患者中，有 4 例在稳定前持续发生>3 次半脱位。
总体而言，因前肩盂唇下脱位导致 Bankart 病变的患者接受手术稳定治疗后获得了良好的结果。19 例至少随访 2 年的患者中，总的复发率为 6 例（31%），在这个年轻、活跃的患者队列中，没有脱位的病例。开放或关节镜稳定治疗没有显著获益，我们确实发现，与慢性复发性半脱位患者（>3 次事件）相比，半脱位患者（≤3 次事件）的稳定性治疗结果更好。我们建议对因前盂唇下脱位而导致 Bankart 病变的年轻运动员进行早期手术稳定治疗。
