França Flávio de Oliveira, Godinho André Couto, Carneiro Leal Diego Pedrosa Capitol, Mantovani Mateus Matos, Frazão Rafael Rodrigues, Mariz Ricardo Ferreira
Hospital Ortopédico, Belo Horizonte, MG, Brasil.
Hospital Belvedere, Belo Horizonte, MG, Brasil.
Rev Bras Ortop (Sao Paulo). 2019 Feb;54(1):13-19. doi: 10.1016/j.rbo.2017.10.010. Epub 2019 Mar 1.
To evaluate the functional outcome of the remplissage technique, the healing of the capsulotenodesis of the infraspinatus tendon in Hill-Sachs lesion, and the degree of fatty infiltration of the infraspinatus muscle and its postoperative strength.
Twenty-five patients with recurrent anterior dislocation of the shoulder and Hill-Sachs lesion with a Hardy index > 20% who underwent the remplissage arthroscopic technique were evaluated with a minimum follow-up of 1 year. Patients underwent a clinical evaluation (Carter-Rowe and Walch-Duplay functional scores, measurement of range of motion and strength) and a magnetic resonance imaging (MRI) exam on the operated shoulder.
Eighty-eight percent and 92% of the patients had good or excellent scores in the functional assessments of the Carter-Rowe and Walch-Duplay scores, respectively. A mean difference of - 1 kg in the strength of the operated limb was observed when compared with the contralateral limb ( < 0.001), as well as a mean difference of 10° in external rotation 1 and 2 ( < 0.001), also compared with the contralateral side. All of the patients who underwent an MRI exam presented high-grade filling of the Hill-Sachs lesion by capsulotenodesis, as well as absence of or minimal fatty infiltration in the infraspinatus muscle.
The remplissage technique had good/excellent functional score results, despite the discrete, albeit statistically significant, loss of strength and of external rotation amplitude. Successful capsulotenodesis healing and filling of the Hill-Sachs defect were demonstrated.
评估 remplissage 技术的功能结果、Hill-Sachs 损伤中冈下肌腱关节囊固定术的愈合情况、冈下肌脂肪浸润程度及其术后力量。
对 25 例复发性肩关节前脱位且 Hardy 指数>20%的 Hill-Sachs 损伤患者进行 remplissage 关节镜技术治疗，至少随访 1 年。患者接受临床评估（Carter-Rowe 和 Walch-Duplay 功能评分、活动范围和力量测量）以及患侧肩部的磁共振成像（MRI）检查。
分别有 88%和 92%的患者在 Carter-Rowe 和 Walch-Duplay 评分的功能评估中获得良好或优秀成绩。与对侧肢体相比，患侧肢体力量平均差异为 -1 kg（<0.001），外旋 1 和 2 的平均差异为 10°（与对侧相比，<0.001）。所有接受 MRI 检查的患者均显示关节囊固定术对 Hill-Sachs 损伤进行了高度填充，且冈下肌无脂肪浸润或仅有轻微脂肪浸润。
尽管力量和外旋幅度有轻微但具有统计学意义的下降，remplissage 技术仍取得了良好/优秀的功能评分结果。证明了关节囊固定术愈合成功且 Hill-Sachs 缺损得到填充。
