Department of Orthopedics, Deventer Hospital, Deventer, The Netherlands.
Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
J Shoulder Elbow Surg. 2019 May;28(5):e137-e143. doi: 10.1016/j.jse.2018.09.027. Epub 2018 Dec 18.
The most common surgical technique in traumatic anterior shoulder instability is the arthroscopic Bankart repair, which has excellent short-term results. The long-term results of the arthroscopic Bankart repair are less frequently studied, with a high recurrence rate of 23% to 35%. The aim of this study was to evaluate the medium-term to long-term results of arthroscopic Bankart repair using suture anchors and to identify specific risk factors for recurrent instability.
Included were 147 patients after traumatic anterior shoulder dislocation who underwent an arthroscopic Bankart repair. The primary outcome was recurrent instability, defined as dislocation or subluxation as perceived by the patients. The secondary outcome was subjective shoulder stability and function as well as quality of life, evaluated using the Western Ontario Shoulder Instability Index, the Simple Shoulder Test, and the 12-Item Short Form Health Survey. Prognostic factors for recurrent instability were analyzed.
Recurrent instability occurred in 22% of patients with a mean follow-up of 6.3 years. Survival at 5 and 10 years without recurrent instability was 79% and 78%, respectively (95% confidence interval, 72%-85% and 71%-85%, respectively). The Western Ontario Shoulder Instability Index score, the Simple Shoulder Test score, and the 12-item Short Form Physical Component Summary improved significantly in the nonrecurrence group (P < .001, P = .004, and P = .002, respectively). Younger age and use of fewer than 3 anchors were associated with a higher risk of recurrent dislocation (P = .008 and P = .039, respectively).
We found an overall recurrent instability rate of 22% (dislocation or subluxation). Good long-term results were observed after arthroscopic Bankart repair in patients older than 20 years with 3 or more suture anchors used.
创伤性前肩不稳定最常见的手术技术是关节镜下 Bankart 修复术，其短期效果极佳。关节镜下 Bankart 修复术的长期效果研究较少，复发率为 23%至 35%。本研究旨在评估关节镜下 Bankart 修复术使用缝合锚钉的中期至长期效果，并确定复发性不稳定的特定危险因素。
纳入 147 例创伤性前肩脱位患者，行关节镜下 Bankart 修复术。主要结局是复发性不稳定，定义为患者感知的脱位或半脱位。次要结局是使用 Western Ontario 肩不稳定指数、简单肩试验和 12 项简短健康调查评估的主观肩稳定性和功能以及生活质量。分析复发性不稳定的预测因素。
22%的患者出现复发性不稳定，平均随访 6.3 年。5 年和 10 年无复发性不稳定的生存率分别为 79%和 78%（95%置信区间分别为 72%-85%和 71%-85%）。在无复发组中，Western Ontario 肩不稳定指数评分、简单肩试验评分和 12 项简短健康调查物理成分综合评分均显著改善（P<0.001、P=0.004 和 P=0.002）。年龄较小和使用少于 3 个锚钉与复发性脱位的风险增加相关（P=0.008 和 P=0.039）。
我们发现总体复发性不稳定率为 22%（脱位或半脱位）。在年龄大于 20 岁且使用 3 个或更多缝合锚钉的患者中，关节镜下 Bankart 修复术后可获得良好的长期效果。
