Buckup Johannes, Welsch Frederic, Hoffmann Reinhard, Roessler Philip P, Schüttler Karl F, Stein Thomas
Department of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany.
Department of Sports traumatology, Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany.
Arch Orthop Trauma Surg. 2018 Feb;138(2):155-163. doi: 10.1007/s00402-017-2831-7. Epub 2017 Nov 3.
Recurrent shoulder instability after arthroscopic Bankart repair is still a common complication. For primary Bankart repair studies have shown that the rotator cuff can recover completely. The ability of muscles to regenerate after arthroscopic revision Bankart repair (ARBR) has not been studied. Does the ARBR using a three-portal method allows complete muscle integrity compared with an uninjured imaging control group (ICG)?
Twenty-two (1 female, 21 males) physically active patients (mean age at follow-up 28.5 ± 7.1 years; mean follow-up 27.5 months ± 8.5) were assessed. ARBR with a three-portal method was carried out in all patients according to previous primary arthroscopic stabilization of the shoulder (revision Bankart group). Muscle atrophy of the subscapularis muscle (SSC), supraspinatus muscle (SSP) and infraspinatus muscle (ISP) was assessed by making lateral and vertical measurements by magnetic resonance imaging (MRI). Fatty infiltration was detected by standardized assessment from variations in intensity. Detailed clinical examination of the rotator cuff was carried out. MRI assessment was compared with that of a control group of 22 healthy volunteers of same age and activity level (ICG).
For the SSC, no muscle impairment was noted compared with the ICG [superior atrophy index (sAI), p = 0.439; inferior atrophy index (iAI), p = 0.555; superior fatty infiltration index (sFDI), p = 0.294; inferior fatty infiltration index (iFDI), p = 0.62]. In investigation of the SSP and ISP, fatty infiltration was not shown (FDI, p = 0.454; sFDI, p = 0.504), though persistent muscle atrophy was found even > 2 years after surgery compared with the ICG (AI, p = 0.0025; sAI, p = 0.0009; iAI, p = 0.0004).
ARBR using a three-portal method allowed good muscular integrity compared with the ICG, but with persistent slight muscular atrophy of the SSP and ISP.
关节镜下Bankart修复术后复发性肩关节不稳定仍是常见并发症。对于初次Bankart修复，研究表明肩袖可完全恢复。关节镜下Bankart修复翻修术（ARBR）后肌肉的再生能力尚未得到研究。与未受伤的影像对照组（ICG）相比，采用三通道方法的ARBR是否能使肌肉保持完整？
对22例（1例女性，21例男性）身体活跃的患者进行评估（随访时平均年龄28.5±7.1岁；平均随访27.5个月±8.5个月）。根据先前的肩关节初次关节镜稳定术，对所有患者采用三通道方法进行ARBR（翻修Bankart组）。通过磁共振成像（MRI）进行横向和纵向测量，评估肩胛下肌（SSC）、冈上肌（SSP）和冈下肌（ISP）的肌肉萎缩情况。通过强度变化的标准化评估检测脂肪浸润情况。对肩袖进行详细的临床检查。将MRI评估结果与22名年龄和活动水平相同的健康志愿者对照组（ICG）进行比较。
对于SSC，与ICG相比未发现肌肉损伤[上萎缩指数（sAI），p = 0.439；下萎缩指数（iAI），p = 0.555；上脂肪浸润指数（sFDI），p = 0.294；下脂肪浸润指数（iFDI），p = 0.62]。在对SSP和ISP的研究中，未显示脂肪浸润（FDI，p = 0.454；sFDI，p = 0.504），尽管与ICG相比，术后2年多仍发现持续的肌肉萎缩（AI，p = 0.0025；sAI，p = 0.0009；iAI，p = 0.0004）。
与ICG相比，采用三通道方法的ARBR可使肌肉保持良好的完整性，但SSP和ISP存在持续的轻微肌肉萎缩。
