Shaha James S, Cook Jay B, Rowles Douglas J, Bottoni Craig R, Shaha Steven H, Tokish John M
Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii
Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii.
J Bone Joint Surg Am. 2016 Nov 16;98(22):1918-1923. doi: 10.2106/JBJS.15.01099.
Glenoid and humeral bone loss are well-described risk factors for failure of arthroscopic shoulder stabilization. Recently, consideration of the interactions of these types of bone loss (bipolar bone loss) has been used to determine if a lesion is "on-track" or "off-track." The purpose of this study was to study the relationship of the glenoid track to the outcomes of arthroscopic Bankart reconstructions.
Over a 2-year period, 57 shoulders that were treated with an isolated, primary arthroscopic Bankart reconstruction performed at a single facility were included in this study. The mean patient age was 25.5 years (range, 20 to 42 years) at the time of the surgical procedure, and the mean follow-up was 48.3 months (range, 23 to 58 months). Preoperative magnetic resonance imaging was used to determine glenoid bone loss and Hill-Sachs lesion size and location and to measure the glenoid track to classify the shoulders as on-track or off-track. Outcomes were assessed according to shoulder stability on examination and subjective outcome.
There were 10 recurrences (18%). Of the 49 on-track patients, 4 (8%) had treatment that failed compared with 6 (75%) of 8 off-track patients (p = 0.0001). Six (60%) of 10 patients with recurrence of instability were off-track compared with 2 (4%) of 47 patients in the stable group (p = 0.0001). The positive predictive value of an off-track measurement was 75% compared with 44% for the predictive value of glenoid bone loss of >20%.
The application of the glenoid track concept to our cohort was superior to using glenoid bone loss alone with regard to predicting postoperative stability. This method of assessment is encouraged as a routine part of the preoperative evaluation of all patients under consideration for arthroscopic anterior stabilization.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
肩胛盂和肱骨头骨质流失是关节镜下肩关节稳定术失败的明确危险因素。最近，考虑这些类型骨质流失的相互作用（双极骨质流失）已被用于确定损伤是“在轨迹上”还是“偏离轨迹”。本研究的目的是研究肩胛盂轨迹与关节镜下Bankart重建术结果之间的关系。
在两年期间，本研究纳入了57例在单一机构接受孤立的初次关节镜下Bankart重建术治疗的肩关节。手术时患者的平均年龄为25.5岁（范围20至42岁），平均随访时间为48.3个月（范围23至58个月）。术前磁共振成像用于确定肩胛盂骨质流失、Hill-Sachs损伤的大小和位置，并测量肩胛盂轨迹以将肩关节分类为在轨迹上或偏离轨迹。根据检查时的肩关节稳定性和主观结果评估结果。
有10例复发（18%）。在49例在轨迹上的患者中，4例（8%）治疗失败，而8例偏离轨迹的患者中有6例（75%）治疗失败（p = 0.0001）。10例不稳定复发患者中有6例（60%）偏离轨迹，而稳定组47例患者中有2例（4%）偏离轨迹（p = 0.0001）。偏离轨迹测量的阳性预测值为75%，而肩胛盂骨质流失>20%的预测值为44%。
在预测术后稳定性方面，将肩胛盂轨迹概念应用于我们的队列优于单独使用肩胛盂骨质流失。作为所有考虑关节镜下前路稳定术患者术前评估的常规部分，鼓励采用这种评估方法。
治疗性III级。有关证据水平的完整描述，请参阅作者须知。
