Hughes Jessica L, Bastrom Tracey, Pennock Andrew T, Edmonds Eric W
Baylor Scott and White, Temple, Texas, USA.
Rady Children's Hospital, San Diego, California, USA.
Orthop J Sports Med. 2018 Dec 14;6(12):2325967118813981. doi: 10.1177/2325967118813981. eCollection 2018 Dec.
Recurrent shoulder dislocation after surgical intervention in adolescents with anterior instability is now understood to occur with a relatively high frequency. The remplissage procedure is successfully used in the adult population to mitigate the ability of a Hill-Sachs lesion to engage the anterior glenoid and can be used during an arthroscopic Bankart repair for anterior shoulder instability.
To compare the clinical outcomes in adolescent patients who underwent a Bankart repair with or without remplissage for treatment of recurrent anterior shoulder instability and associated Hill-Sachs defects.
Cohort study; Level of evidence, 3.
A retrospective review was conducted on adolescents who underwent a remplissage procedure for recurrent anterior shoulder instability from 2009 to 2017 at a single institution. Controls were identified in a cohort of patients who underwent a Bankart repair only and were matched based on age, sex, and size of Hill-Sachs lesion. All patients were then contacted to determine instability recurrence as well as to complete the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) and the Pediatric Adolescent Shoulder Score (PASS) outcome surveys.
Twenty-one adolescents underwent a remplissage procedure, and 20 matched controls underwent only a Bankart procedure. A significantly higher rate of recurrence was noted in the Bankart-only patients (8/17) compared with remplissage patients (2/15) ( = .04). No statistical difference was found in patient-reported outcome scores between treatment groups or in range of motion measurements ( > .05). In a subset of patients in the remplissage group with pre- and postoperative surveys available, mean ± SD scores for PASS (77 ± 11) and QuickDASH (19 ± 12) improved when compared with preoperative scores (PASS, 54 ± 16; QuickDASH, 35 ± 28), but only the PASS score was statistically improved (PASS, = .003; QuickDASH, = .23).
The addition of the remplissage procedure to a Bankart repair is a reasonable surgical option to treat a Hill-Sachs deformity in adolescents with anterior shoulder instability. The success of this additional procedure may be due to filling the Hill-Sachs defect, or perhaps it augments stability through a mechanism of posterior capsulorrhaphy. Either way, this young athletic population appears to have a lower rate of recurrence and improved patient-reported outcomes with a remplissage procedure to address the Hill-Sachs deformity.
目前已知青少年前向不稳定患者手术干预后复发性肩关节脱位的发生率相对较高。Remplissage手术已成功应用于成人，以减轻希尔-萨克斯损伤与前方关节盂的嵌合能力，并且可在关节镜下Bankart修复治疗前向肩关节不稳定时使用。
比较接受或未接受Remplissage手术治疗复发性前向肩关节不稳定及相关希尔-萨克斯缺损的青少年患者的临床疗效。
队列研究；证据等级，3级。
对2009年至2017年在单一机构接受Remplissage手术治疗复发性前向肩关节不稳定的青少年进行回顾性研究。在仅接受Bankart修复手术的患者队列中确定对照组，并根据年龄、性别和希尔-萨克斯损伤大小进行匹配。然后联系所有患者以确定不稳定复发情况，并完成上肢、肩部和手部功能障碍简化版（QuickDASH）以及青少年肩部评分（PASS）结果调查。
21名青少年接受了Remplissage手术，20名匹配的对照组仅接受了Bankart手术。仅接受Bankart手术的患者（8/17）复发率显著高于接受Remplissage手术的患者（2/15）（P = 0.04）。治疗组之间患者报告的结果评分或活动度测量结果均无统计学差异（P>0.05）。在Remplissage组中有术前和术后调查数据的患者亚组中，与术前评分（PASS，54±16；QuickDASH，35±28）相比，PASS（77±11）和QuickDASH（19±12）的平均±标准差评分有所改善，但只有PASS评分有统计学意义的改善（PASS，P = 0.003；QuickDASH，P = 0.23）。
在Bankart修复手术中增加Remplissage手术是治疗前向肩关节不稳定青少年患者希尔-萨克斯畸形的合理手术选择。这一附加手术的成功可能是由于填充了希尔-萨克斯缺损，或者可能是通过后方关节囊缝合的机制增强了稳定性。无论哪种方式，对于这一年轻的运动员群体，采用Remplissage手术治疗希尔-萨克斯畸形似乎复发率较低且患者报告的结果有所改善。
