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关节镜下改良Bankart修复术后重返运动

Back to Sports After Arthroscopic Revision Bankart Repair.

作者信息

Buckup Johannes, Welsch Frederic, Gramlich Yves, Hoffmann Reinhard, Roessler Philip P, Schüttler Karl F, Stein Thomas

机构信息

Department of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany.

Department of Sporttraumatology, Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany.

出版信息

Orthop J Sports Med. 2018 Feb 21;6(2):2325967118755452. doi: 10.1177/2325967118755452. eCollection 2018 Feb.

Abstract

BACKGROUND

Recurrent instability following primary arthroscopic stabilization of the shoulder is a common complication. Young, athletic patients are at the greatest risk of recurring instability. To date, the literature contains insufficient description regarding whether return to sports is possible after revision arthroscopic Bankart repair.

HYPOTHESIS

Patients presenting with recurrent instability after primary arthroscopic stabilization should expect limitations in terms of their ability to partake in sporting activities after revision surgery.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Twenty athletes who underwent arthroscopic revision stabilization of the shoulder after failed primary arthroscopic Bankart repair were included in the study after completing inclusion and exclusion criteria surveys. Athletic Shoulder Outcome Scoring System (ASOSS), Shoulder Sport Activity Score (SSAS), and the Subjective Patient Outcome for Return to Sports (SPORTS) scores were determined to assess the participants' ability to partake in sporting activities. Furthermore, sport type and sport level were classified and recorded. To assess function and stability, Rowe, American Shoulder and Elbow Surgeons, Constant-Murley, and Walch-Duplay scores were measured and recorded.

RESULTS

Follow-up consultations were carried out after a mean of 28.7 months. The mean age at follow-up examination was 27.75 years. At the time of follow-up, 70% of the patients were able to return to their original sporting activities at the same level. However, 90% of patients described a limitation in their shoulder when participating in their sports. At 28.7 months after surgery, the mean ASOSS score was 76.8; the SSAS score decreased from 7.85 before first-time dislocation to 5.35 at follow-up ( < .005). The SPORTS score was 5.2 out of 10 at the follow-up consultation. Function- and instability-specific scores showed good to excellent results. The mean external rotational deficit for high external rotation was 9.25°, and for low external rotation it was 12°.

CONCLUSION

Patients can return to their original type and level of sport after arthroscopic revision Bankart repair, but they must expect persistent deficits and limitations to the shoulder when put under the strains of sporting activity. Patients with shoulder injuries who partake in sports that put greater demand on the shoulder show the smallest probabilities of returning to sporting activity.

摘要

背景

初次肩关节镜稳定修复术后复发性不稳定是一种常见并发症。年轻的运动员患者复发性不稳定的风险最高。迄今为止,关于关节镜下Bankart修复翻修术后能否恢复运动,文献中描述不足。

假设

初次关节镜稳定修复术后出现复发性不稳定的患者,翻修手术后在参与体育活动的能力方面会受到限制。

研究设计

病例系列;证据等级,4级。

方法

20名初次关节镜下Bankart修复失败后接受关节镜翻修稳定修复术的运动员,在完成纳入和排除标准调查后纳入研究。采用运动肩关节结果评分系统(ASOSS)、肩部运动活动评分(SSAS)和主观患者恢复运动结果(SPORTS)评分来评估参与者参与体育活动的能力。此外,对运动类型和运动水平进行分类并记录。为评估功能和稳定性,测量并记录Rowe评分、美国肩肘外科医师协会评分、Constant-Murley评分和Walch-Duplay评分。

结果

平均28.7个月后进行随访。随访检查时的平均年龄为27.75岁。随访时,70%的患者能够恢复到原来相同水平的体育活动。然而,90%的患者表示在参加运动时肩部有受限情况。术后28.7个月时,平均ASOSS评分为76.8;SSAS评分从首次脱位前的7.85降至随访时的5.35(P<0.005)。随访咨询时SPORTS评分为5.2(满分10分)。功能和不稳定相关评分显示出良好至优秀的结果。高外旋时平均外旋缺损为9.25°,低外旋时为12°。

结论

关节镜下Bankart修复翻修术后患者可以恢复到原来的运动类型和水平,但在承受体育活动压力时,他们必须预期肩部会持续存在功能缺损和受限情况。参与对肩部要求更高运动的肩部损伤患者恢复运动的可能性最小。

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