Miyamoto Ryosuke, Yamamoto Atsushi, Shitara Hitoshi, Ichinose Tsuyoshi, Shimoyama Daisuke, Sasaki Tsuyoshi, Hamano Noritaka, Kobayashi Tsutomu, Osawa Toshihisa, Takagishi Kenji
Gunma University Graduate School of Medicine - Orthopaedic Surgery, Maebashi, Gunma, Japan.
St. Pierre Hospital - Orthopaedic Surgery, Takasaki, Gunma, Japan.
Open Orthop J. 2017 Nov 10;11:1268-1276. doi: 10.2174/1874325001711011268. eCollection 2017.
We aimed to assess functional outcomes and postoperative recurrence rate associated with the remplissage procedure used for bone augmentation with Bankart repair in patients with Hill-Sachs lesions after shoulder dislocation.
Preoperative computed tomography was performed to check for bony Bankart lesions,calculate the bone defect rate, and estimate the risk for re-dislocation. Functional and clinical scores were assessed preoperatively and at three months, six months, and one year postoperatively.
Between 2011 and 2014, 18 patients (17 male; age at surgery, 29.0±10.4 years; 18 affected shoulders) underwent arthroscopic Bankart repair with arthroscopic remplissage (remplissage group), and 18 sex- and age-matched controls underwent arthroscopic Bankart repair alone (control group). The incidence of bony Bankart lesion and glenoid bone defect was significantly higher in the remplissage group. No complications, re-dislocation, or re-subluxation was noted during or after the operation. Postoperatively, the range of motion and muscular weakness alleviated with time, and the clinical scores improved significantly from the preoperative values. However, the remplissage group showed significantly restricted shoulder flexion, abduction, internal rotation and external rotation even at one year postoperatively. Compared to the control group, the remplissage group showed significantly lower Rowe scores preoperatively, and both Rowe scores and University of California-Los Angeles scale scores remained significantly lower throughout the one-year follow-up.
Despite some restriction of external rotation, remplissage leads to better clinical scores and no recurrence, providing a valid means of augmentation for Bankart repair in high-risk patients with engaged Hill-Sachs lesion.
我们旨在评估用于肩关节脱位后存在Hill-Sachs损伤患者的Bankart修复术中骨填充手术相关的功能结局和术后复发率。
术前行计算机断层扫描以检查骨性Bankart损伤、计算骨缺损率并评估再脱位风险。术前及术后3个月、6个月和1年评估功能和临床评分。
2011年至2014年，18例患者（17例男性；手术年龄29.0±10.4岁；18个患肩）接受了关节镜下Bankart修复联合关节镜下骨填充术（骨填充组），18例年龄和性别匹配的对照者仅接受了关节镜下Bankart修复术（对照组）。骨填充组骨性Bankart损伤和肩胛盂骨缺损的发生率显著更高。手术期间及术后未发现并发症、再脱位或再半脱位。术后，随着时间推移，活动范围和肌肉无力症状有所缓解，临床评分较术前显著改善。然而，骨填充组即使在术后1年时，肩关节前屈、外展、内旋和外旋仍明显受限。与对照组相比，骨填充组术前Rowe评分显著更低，且在整个1年随访期间，Rowe评分和加利福尼亚大学洛杉矶分校（UCLA）评分均显著更低。
尽管外旋存在一定受限，但骨填充术可带来更好的临床评分且无复发，为存在嵌顿性Hill-Sachs损伤的高危患者的Bankart修复提供了一种有效的增强手段。
