关节镜下 Bankart 手术后 13 年的再脱位率为 10%。
Ten percent re-dislocation rate 13 years after the arthroscopic Bankart procedure.
机构信息
Department of Orthopedics, OLVG, Amsterdam, The Netherlands.
Quality and Safety Department, Unit Value-Based Healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2019 Dec;27(12):3929-3936. doi: 10.1007/s00167-019-05534-y. Epub 2019 May 23.
PURPOSE
The aim of the present study was to determine the long-term outcome after the arthroscopic Bankart procedure, in terms of recurrent instability, shoulder function, glenohumeral arthropathy and patient satisfaction.
METHODS
Patients who underwent the arthroscopic Bankart procedure between January 1999 and the end of December 2005 were invited to complete a set of Patient Reported Outcome Measures (PROMs) and visit the hospital for clinical and radiological assessment. PROMs included the Western Ontario Shoulder Instability Index (WOSI), the Oxford Shoulder Instability Score (OSIS) and additional questions on shoulder instability and patient satisfaction. Clinical assessment included the apprehension test and the Constant-Murley score. The Samilson-Prieto classification was used to assess arthropathy on standard radiographs. The primary outcome was a re-dislocation that needed reduction. Secondary outcomes in terms of recurrent instability included patient-reported subluxation and a positive apprehension test.
RESULTS
Of 104 consecutive patients, 71 patients with a mean follow-up of 13.1 years completed the PROMs, of which 53 patients (55 shoulders) were also available for clinical and radiological assessment. Re-dislocations had occurred in 7 shoulders (9.6%). Subluxations occurred in 23 patients (31.5%) and the apprehension test was positive in 30 (54.5%) of the 55 shoulders examined. Median functional outcomes were 236 for WOSI, 45 for OSIS, and 103 for the normalized Constant-Murley score. Of all 71 patients (73 shoulders), 29 (39.7%) reported being completely satisfied, 33 (45.2%) reported being mostly satisfied and 8 (11%) reported being somewhat satisfied. Glenohumeral arthropathy was observed in 33 (60%) of the shoulders.
CONCLUSION
Despite 10% re-dislocations and frequent other signs of recurrent instability, shoulder function and patient satisfaction at 13 years after arthroscopic Bankart repair were good.
LEVEL OF EVIDENCE
Level IV.
目的
本研究旨在评估关节镜下 Bankart 修复术治疗肩关节前脱位的长期疗效，包括复发性不稳定、肩关节功能、肩关节炎和患者满意度。
方法
本研究纳入了 1999 年 1 月至 2005 年 12 月期间接受关节镜下 Bankart 修复术的患者，邀请他们完成一套患者报告的结局测量（PROMs）并到医院进行临床和影像学评估。PROMs 包括 Western Ontario Shoulder Instability Index（WOSI）、Oxford Shoulder Instability Score（OSIS）以及关于肩关节不稳定和患者满意度的附加问题。临床评估包括恐惧试验和 Constant-Murley 评分。Samilson-Prieto 分类用于评估标准 X 线片上的关节炎。主要结局为需要复位的再脱位。复发性不稳定的次要结局包括患者报告的半脱位和阳性恐惧试验。
结果
104 例连续患者中，71 例（71 肩）平均随访 13.1 年完成了 PROMs，其中 53 例（55 肩）还可进行临床和影像学评估。7 例（9.6%）发生再脱位，23 例（31.5%）发生半脱位，30 例（54.5%）检查的 55 肩恐惧试验阳性。WOSI 的中位数功能结局为 236，OSIS 为 45，标准化 Constant-Murley 评分的中位数为 103。71 例患者（73 肩）中，29 例（39.7%）报告完全满意，33 例（45.2%）报告基本满意，8 例（11%）报告满意。33 例（60%）的肩出现肩关节炎。
结论
尽管有 10%的再脱位和频繁的其他复发性不稳定迹象，但关节镜下 Bankart 修复术后 13 年时，肩关节功能和患者满意度仍然较好。
证据等级
IV 级。
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