Orthopaedic Surgery Department, Hôpital Saint Antoine, Assistance Publique, Hôpitaux de Paris, Paris, France.
Groupe Maussins, Clinique de l'épaule, Clinique Maussins Nollet, Groupe Ramsay Générale de Santé, Paris, France.
Arthroscopy. 2019 May;35(5):1362-1367. doi: 10.1016/j.arthro.2019.01.013. Epub 2019 Apr 12.
To evaluate the global function of patients treated by arthroscopic shoulder stabilization with or without remplissage at a minimum of 10 years of follow-up.
The inclusion criteria were existence of a recurrent anterior shoulder dislocation, with or without a Hill-Sachs lesion. The exclusion criteria were prior shoulder stabilization surgery and patients with a glenoid lesion that had been stabilized using the Latarjet procedure. Included patients with a Hill-Sachs lesion underwent surgical remplissage, and the others had Bankart repair only. The main criterion for failure was recurrence of instability or apprehension. The Rowe score and the Walch-Duplay score were used to assess shoulder function before surgery and 10 years afterward, in clinical reviews or telephone interviews.
Seventy-nine patients underwent surgical Bankart repair with or without remplissage between November 2004 and January 2008 and were followed up for a mean duration of 128 months (range, 120-150); 12 patients were lost to follow-up, and 39 patients had Bankart stabilization only: the mean Instability Severity Index Score was 2.3 (range, 0-6). Three patients had recurrence with new dislocation, and 8 patients had apprehension. The Rowe score progressed from 54.3 (range, 25-65) to 83.8 (range, 70-100; P < .01), and the Walch-Duplay score rose from 46.8 (range, 25-75) to 85.6 (range 70-100; P < .01). Twenty-eight patients had arthroscopic Bankart repair + remplissage; the mean Instability Severity Index Score was 1.8 (range, 1-4). There was no recurrence, and no patient had apprehension. The Rowe score progressed from 51.8 (range, 20-65) to 92.3 (range, 70-100; P < .01), and the Walch-Duplay score rose from 58.7 (range, 30-75) to 91.4 (range, 70-100; P < .01). Functional scores in the second group were statistically significant better than in the first one.
Bankart repair combined with remplissage seems to be an effective method for restoring joint stability in patients with recurrent anterior shoulder dislocation with an associated Hill-Sachs lesion at a minimum of 10 years of follow-up. This technique appears to deliver better functional results than Bankart repair only, showing better scores for mobility and stability in the remplissage group. Limitations (pain and restriction of motion) reported in literature at short-term follow-up for this technical procedure do not seem to be anymore an issue at long-term follow-up.
Level III, retrospective comparative study.
评估在至少 10 年随访时行关节镜下肩关节稳定术治疗的患者的整体功能。
纳入标准为复发性前肩脱位，伴或不伴 Hill-Sachs 损伤。排除标准为既往肩稳定术和使用 Latarjet 术稳定的盂唇损伤。伴 Hill-Sachs 损伤的患者行手术填充治疗，其他患者仅行 Bankart 修复术。失败的主要标准是再次不稳定或出现交锁感。在临床评估或电话访谈中，使用 Rowe 评分和 Walch-Duplay 评分评估术前和术后 10 年的肩部功能。
2004 年 11 月至 2008 年 1 月间，79 例患者行关节镜下 Bankart 修复术+填充术治疗，平均随访 128 个月（120-150 个月）；12 例患者失访，39 例患者仅行 Bankart 稳定术：平均不稳定严重指数评分 2.3（0-6）。3 例患者出现新发脱位，8 例患者出现交锁感。Rowe 评分从 54.3（25-65）升高至 83.8（70-100；P<0.01），Walch-Duplay 评分从 46.8（25-75）升高至 85.6（70-100；P<0.01）。28 例患者行关节镜下 Bankart 修复术+填充术，平均不稳定严重指数评分 1.8（1-4）。无复发，无患者出现交锁感。Rowe 评分从 51.8（20-65）升高至 92.3（70-100；P<0.01），Walch-Duplay 评分从 58.7（30-75）升高至 91.4（70-100；P<0.01）。第二组的功能评分明显优于第一组。
在至少 10 年的随访中，Bankart 修复术联合填充术似乎是治疗伴有 Hill-Sachs 损伤的复发性前肩脱位患者恢复关节稳定性的有效方法。与仅行 Bankart 修复术相比，该技术似乎能提供更好的功能结果，填充组的活动度和稳定性评分更好。在短期随访中，该技术的报告限制（疼痛和运动受限）在长期随访中似乎不再是问题。
III 级，回顾性比较研究。
