Hatch Mark D, Hennrikus William L
Department of Orthopaedic Surgery, Penn State College of Medicine, Hershey, PA.
J Pediatr Orthop. 2018 Jan;38(1):27-31. doi: 10.1097/BPO.0000000000000744.
Traumatic anterior shoulder instability from recurrent dislocations or subluxations is a debilitating problem for the teenage athlete. The risk of recurrent instability is high in this adolescent population. We performed a retrospective case series analysis of adolescent athletes with recurrent instability treated with open Bankart repair and evaluated functional outcomes as well as redislocation rates.
The retrospective study included 21 teenage patients with Bankart lesions and recurrent anterior shoulder instability. There were 19 males (90%) and 2 females (10%) with an average age of 16 years (range, 14 to 18 y). Patients were evaluated based on Rowe and UCLA shoulder scores, return to previous level of sport, external rotation, and recurrence.
The average number of anchors used to repair the Bankart lesion was 3 (range, 2 to 5). One patient was lost to follow-up at 6 months after surgery. The remaining 20 patients all had at least 2-year follow-up. The recurrent instability rate was zero. In total, 100% of patients had an excellent result based on an average Rowe score of 96.5 points of 100 points (a score of 90 to 100 is an excellent result). In total, 100% of patients had good/excellent result based on an average UCLA shoulder score of 34 of 35 (a score >27 is a good/excellent result). At final follow-up, 7 patients (34%) had lost an average of 11 degrees of external rotation (range, 5 to 20 degrees) on the injured shoulder with the arm at the side compared with the noninjured shoulder.
Contact teenage athletes with recurrent anterior shoulder instability can be treated with open Bankart repair with a low recurrence, excellent functional shoulder outcomes, and return to sport. A small amount of external rotation may be lost with this technique. Care must be taken when considering this method with throwing athletes (ie, quarterback or pitcher). The open Bankart should remain a viable alternative for the adolescent population with recurrent anterior instability.
Level IV.
复发性脱位或半脱位导致的创伤性前肩不稳是青少年运动员面临的一个使人衰弱的问题。在这个青少年群体中，复发性不稳的风险很高。我们对接受开放性Bankart修复术治疗的复发性不稳的青少年运动员进行了一项回顾性病例系列分析，并评估了功能结果以及再脱位率。
这项回顾性研究纳入了21例患有Bankart损伤和复发性前肩不稳的青少年患者。其中男性19例（90%），女性2例（10%），平均年龄16岁（范围14至18岁）。根据Rowe和UCLA肩部评分、恢复到先前运动水平的情况、外旋以及复发情况对患者进行评估。
修复Bankart损伤所用锚钉的平均数量为3个（范围2至5个）。1例患者在术后6个月失访。其余20例患者均有至少2年的随访。再脱位率为零。总体而言，基于平均Rowe评分为100分中的96.5分（评分90至100分为优秀结果），100%的患者结果为优秀。基于平均UCLA肩部评分为35分中的34分（评分>27分为良好/优秀结果），100%的患者结果为良好/优秀。在末次随访时，与未受伤侧肩部相比，7例患者（34%）受伤侧肩部手臂处于体侧时平均外旋丧失了 11度（范围5至20度）。
患有复发性前肩不稳的青少年运动员可以通过开放性Bankart修复术进行治疗，复发率低，肩部功能结果优异，且能恢复运动。采用这种技术可能会有少量外旋丧失。对于投掷运动员（如四分卫或投手）考虑采用这种方法时必须谨慎。开放性Bankart修复术对于患有复发性前不稳的青少年人群应仍然是一种可行的选择。
四级。
