Kim Sung-Jae, Choi Chong-Hyuk, Choi Yun-Rak, Lee Wonyong, Jung Woo-Seok, Chun Yong-Min
Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, CPO Box 8044, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
J Orthop Surg Res. 2018 Apr 11;13(1):80. doi: 10.1186/s13018-018-0791-4.
No previously published studies have examined recurrent traumatic incomplete events in patients with excessive joint laxity. The purpose of this study is to investigate outcomes after arthroscopic stabilization for recurrent traumatic shoulder subluxation in patients with excessive joint laxity but no history of dislocation.
This study included 23 patients with glenoid bone defects less than 20% who underwent arthroscopic stabilization of recurrent shoulder subluxation and were available for at least 2 years follow-up. Outcomes were assessed with the subjective shoulder value (SSV), University of California Los Angeles (UCLA) shoulder score, Rowe score, and sports/recreation activity level.
Postoperatively, overall functional scores improved significantly (p < 0.001), compared to preoperative scores: SSV improved from 49.1 to 90.4; Rowe score improved from 36.7 to 90.2; and UCLA shoulder score improved from 26.3 to 32.5. Patient satisfaction rate was 87% (20/23 patients). Sports/recreation activity level (return to premorbid activity level; grade I = 100% to grade IV = less than 70%) was grade I in 7 patients, grade II in 11, grade III in 3, grade IV in 2. The incidence of any glenoid bone defect was 61% (14/23 patients), and the mean glenoid bone defect size was 8%; among these 14 patients, 8 (35%) exhibited 15-20% glenoid bone defects. Instability reoccurred in 2 patients (9%) who had 15-20% glenoid bone defect.
Despite excessive joint laxity, overall functional outcomes after arthroscopic stabilization of recurrent shoulder subluxation were satisfactory. However, arthroscopic Bankart repair may not be reliable in patients with excessive joint laxity plus a glenoid bone defect size of more than approximately 15%.
既往尚无已发表的研究探讨关节过度松弛患者复发性创伤性不完全事件。本研究的目的是调查关节镜下稳定术治疗关节过度松弛但无脱位病史的复发性创伤性肩关节半脱位后的疗效。
本研究纳入23例关节盂骨缺损小于20%的患者，这些患者接受了关节镜下复发性肩关节半脱位稳定术，且至少有2年的随访资料。采用主观肩关节值（SSV）、加利福尼亚大学洛杉矶分校（UCLA）肩关节评分、Rowe评分以及运动/娱乐活动水平对疗效进行评估。
术后，与术前评分相比，总体功能评分显著改善（p < 0.001）：SSV从49.1提高到90.4；Rowe评分从36.7提高到90.2；UCLA肩关节评分从26.3提高到32.5。患者满意率为87%（20/23例患者）。运动/娱乐活动水平（恢复到病前活动水平；I级 = 100%至IV级 = 小于70%）：7例患者为I级，11例为II级，3例为III级，2例为IV级。任何关节盂骨缺损的发生率为61%（14/23例患者），关节盂骨缺损平均大小为8%；在这14例患者中，8例（35%）表现为15% - 20%的关节盂骨缺损。2例（9%）关节盂骨缺损为15% - 20%的患者出现了不稳定复发。
尽管关节过度松弛，但关节镜下复发性肩关节半脱位稳定术后的总体功能疗效令人满意。然而，对于关节过度松弛且关节盂骨缺损大小超过约15%的患者，关节镜下Bankart修复可能不可靠。
