Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA.
Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA.
J Shoulder Elbow Surg. 2019 May;28(5):e156-e163. doi: 10.1016/j.jse.2018.11.048. Epub 2019 Jan 23.
The Instability Severity Index (ISI) score is a preoperative risk stratification tool used to identify patients at heightened risk of recurrent anterior instability after an arthroscopic Bankart procedure. The primary objective of this study was to validate the utility of the ISI score in predicting failure of primary arthroscopic Bankart surgery in an active-duty military population.
A retrospective study was performed to compare all military service members undergoing primary arthroscopic Bankart repairs at a single military treatment facility between 2007 and 2014. The primary outcome of interest was surgical failure due to recurrent instability. The ISI framework was used to stratify each patient for recurrence, and multivariate analysis was performed to evaluate the composite ISI score and individual domains between patients with and patients without failed Bankart repairs.
A total of 131 patients were identified, with a mean patient age of 26.8 years (range, 19-47 years), among whom 42 patients (32%) were identified as having a higher-demand military occupation. At a minimum 2-year follow-up, 34 patients (26%) sustained recurrent anterior shoulder instability. The mean ISI score of patients in the failed Bankart repair group was not statistically different than that of patients with a successful repair (3.41 vs 3.5, P = .74), and no individual ISI domains were identified as independent risk factors for subsequent surgical failure or revision stabilization.
Contrary to the findings of previous validation studies, the composite ISI score and its individual risk factors were not predictive of subsequent surgical failure after primary arthroscopic Bankart repair in an active military population.
不稳定严重程度指数（ISI）评分是一种术前风险分层工具，用于识别关节镜下 Bankart 手术后复发性前不稳定风险增加的患者。本研究的主要目的是验证 ISI 评分在预测现役军人关节镜下 Bankart 初次修复手术失败中的作用。
对 2007 年至 2014 年期间在一家军事医疗机构接受初次关节镜 Bankart 修复术的所有现役军人进行回顾性研究。主要研究结果为因复发性不稳定导致手术失败。使用 ISI 框架对每位患者进行复发分层，并进行多变量分析，以评估复合 ISI 评分和个体领域在 Bankart 修复失败和未失败患者之间的差异。
共确定了 131 名患者，平均年龄 26.8 岁（范围，19-47 岁），其中 42 名（32%）患者从事高需求的军事职业。在至少 2 年的随访中，34 名（26%）患者出现复发性前肩不稳定。Bankart 修复失败组的 ISI 评分平均值与修复成功组无统计学差异（3.41 对 3.5，P = .74），且没有任何个体 ISI 领域被确定为随后手术失败或翻修稳定的独立危险因素。
与先前验证研究的结果相反，在现役军人中，复合 ISI 评分及其各个危险因素并不能预测初次关节镜 Bankart 修复后的手术失败。
