Shin Sang-Jin, Kim Rag Gyu, Jeon Yoon Sang, Kwon Tae Hun
Department of Orthopaedic Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea.
Am J Sports Med. 2017 Jul;45(9):1975-1981. doi: 10.1177/0363546517697963. Epub 2017 Mar 23.
Generally, a glenoid bone loss greater than 20% to 25% is considered critical for poor surgical outcomes after a soft tissue repair. However, recent studies have suggested that the critical value should be lower.
To determine the critical value of anterior glenoid bone loss that led to surgical failure in patients with anterior shoulder instability.
Case-control study; Level of evidence, 3.
The study included 169 patients with anterior glenoid erosion. The percentage of glenoid erosion was calculated as the ratio of the glenoid loss width and the glenoid width to the diameter of the outer-fitting circle based on the inferior portion of the glenoid contour. The critical value of the glenoid bone loss was analyzed by means of receiver operating characteristic (ROC) curve analysis. Patients were divided into 2 groups based on the amount of glenoid bone loss: group A (less than the critical value) and group B (more than the critical value). Patients evaluated their shoulder function as a percentage of their preinjury level using the Single Assessment Numeric Evaluation (SANE) score, and postoperative clinical outcomes were assessed with the American Shoulder and Elbow Surgeons (ASES) score and Rowe score. Surgical failure was defined as the need for revision surgery or the presence of subjective symptoms of instability.
The optimal critical value of glenoid bone loss was 17.3% (area under the curve = 0.82; 95% confidence interval, 0.73-0.91; P < .001; sensitivity 75%; specificity 86.6%). Group A and B contained 134 and 35 patients, respectively. Shoulder functional scores were significantly lower in group B than in group A ( P < .001). Five patients (3.7%) in group A and 15 (42.9%) in group B had surgical failure ( P < .001). The SANE score was significantly lower in group B (83.8 ± 12.1) than in group A (92.9 ± 4.7, P = .001).
An anterior glenoid bone loss of 17.3% or more with respect to the longest anteroposterior glenoid width should be considered as the critical amount of bone loss that may result in recurrent glenohumeral instability after arthroscopic Bankart repair.
一般来说，肩胛盂骨丢失超过20%至25%被认为对于软组织修复术后手术效果不佳至关重要。然而，最近的研究表明临界值应更低。
确定导致前肩不稳患者手术失败的肩胛盂前部骨丢失的临界值。
病例对照研究；证据等级，3级。
该研究纳入了169例肩胛盂前部侵蚀患者。肩胛盂侵蚀百分比通过肩胛盂轮廓下部的肩胛盂丢失宽度与肩胛盂宽度与外适配圆直径之比来计算。通过受试者操作特征（ROC）曲线分析来分析肩胛盂骨丢失的临界值。根据肩胛盂骨丢失量将患者分为两组：A组（低于临界值）和B组（高于临界值）。患者使用单评估数字评价（SANE）评分将其肩部功能评估为受伤前水平的百分比，并使用美国肩肘外科医师（ASES）评分和罗威评分评估术后临床结果。手术失败定义为需要翻修手术或存在不稳定的主观症状。
肩胛盂骨丢失的最佳临界值为17.3%（曲线下面积=0.82；95%置信区间，0.73 - 0.91；P <.001；敏感性75%；特异性86.6%）。A组和B组分别包含134例和35例患者。B组的肩部功能评分显著低于A组（P <.001）。A组有5例患者（3.7%）手术失败，B组有15例患者（42.9%）手术失败（P <.001）。B组的SANE评分（83.8±12.1）显著低于A组（92.9±4.7，P =.001）。
相对于肩胛盂最长前后径宽度，肩胛盂前部骨丢失17.3%或更多应被视为关节镜下Bankart修复术后可能导致复发性肩肱关节不稳定的临界骨丢失量。
