Fakih Riad, Hamie Muhieddine Rada, Yassine Mahmoud Sami
J Med Liban. 2016 Jul-Sep;64(3):175-80. doi: 10.12816/0031528.
Conservative treatment of posttraumatic anteroinferior shoulder instability leads to a high failure rate and consequently high recurrence in young and active population. Each recurrence can increase the structural damage of both bony structures and soft tissues (Hill-Sachs lesion, Bankart lesion). Remplissage technique combined with Bankart repair have been proposed as a treatment option.
Early arthroscopic treatment for shoulder dislocation will result in better outcome and lower recurrence rate than nonoperative management.
We retrospectively reviewed 60 cases from 2010 to 2015 treated by remplissage technique with Bankart repair or closed reduction for anterior shoulder dislocation. All surgeries and closed reductions were done by the same surgeon. Mean age of patients was 30 years, most of them males having experienced one or more recurrent dislocations; mean follow-up was 2 years. Patients with Hill-Sachs lesions < 40% on the articular surface and < 20% of bone defect in the glenoid cavity were included. Exclusion criteria were: glenohumeral arthritis or other inflammation, fracture around the shoulder joint, elderly patients with osteoporosis. All patients included in the study were followed up after 6, 12 and 24 months. Rowe score was used to assess the stability of the shoulders and goniometry to assess the range of motion of the glenohumeral joints.
The results confirm that the remplissage technique with Bankart repair takes the upper hand over the conservative management and does not produce any severe adverse effect on postoperative shoulder range of motion. A slight restriction (≈10º) observed in external rotation did not prevent 69% of patients from resuming their preinjury sports activities. At the last follow-up, 90% of patients had a stable shoulder. Conservative management was associated with high rate of recurrence limiting the daily activity of our patients and interfering with their return to sports activities. Except from the recurrence of glenohumeral instability, no patient had a complication following arthroscopic Hill-Sachs remplissage.
Conservative management after anterior shoulder dislocation including immobilization in neutral position leads to significantly higher and unacceptable high failure rate compared with early arthroscopic remplissage with Bankart repair. The slight restriction in external rotation post remplissage does not significantly affect the quality of life and return to sports activities and further supports the use of this safe, relatively short procedure, in the management of glenohumeral instability with concurrent Hill-Sachs lesions.
创伤后肩关节前下不稳的保守治疗在年轻活跃人群中失败率高，复发率也高。每次复发都会增加骨结构和软组织的结构性损伤（希尔-萨克斯损伤、Bankart损伤）。有人提出将 remplissage 技术与Bankart修复术联合作为一种治疗选择。
肩关节脱位的早期关节镜治疗比非手术治疗效果更好，复发率更低。
我们回顾性分析了2010年至2015年采用 remplissage 技术联合Bankart修复术或肩关节前脱位闭合复位治疗的60例患者。所有手术和闭合复位均由同一位外科医生完成。患者平均年龄为30岁，大多数为男性，有过一次或多次复发性脱位；平均随访时间为2年。纳入关节面希尔-萨克斯损伤<40%且肩胛盂骨缺损<20%的患者。排除标准为：盂肱关节炎或其他炎症、肩关节周围骨折、患有骨质疏松症的老年患者。纳入研究的所有患者在6个月、12个月和24个月后进行随访。采用Rowe评分评估肩关节稳定性，用量角器评估盂肱关节活动范围。
结果证实， remplissage 技术联合Bankart修复术优于保守治疗，且对术后肩关节活动范围未产生任何严重不良影响。外旋活动度有轻微受限（约10°），但这并未妨碍69%的患者恢复伤前的体育活动。在最后一次随访时，90%的患者肩关节稳定。保守治疗复发率高，限制了患者的日常活动，影响其恢复体育活动。除盂肱关节不稳复发外，关节镜下希尔-萨克斯损伤 remplissage 术后无患者出现并发症。
与早期关节镜下 remplissage 联合Bankart修复术相比，肩关节前脱位后的保守治疗（包括中立位固定）导致的失败率显著更高且高得不可接受。 remplissage 术后外旋的轻微受限对生活质量和恢复体育活动没有显著影响，进一步支持了在治疗并发希尔-萨克斯损伤的盂肱关节不稳时使用这种安全、相对简短的手术方法。
