骨移植增强在关节镜下 Bankart 修复治疗复发性肩关节前向不稳定伴肩胛盂骨丢失中的作用。

Benefits of bone graft augmentation to arthroscopic Bankart repair for recurrent anterior shoulder instability with glenoid bone loss.

机构信息

Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan.

Department of Orthopaedic Surgery, Hoshigaoka Medical Center of Japan Community Health Care Organization (JCHO), 4-8-1, Hoshigaoka, Hirakata, Osaka, Japan.

出版信息

Knee Surg Sports Traumatol Arthrosc. 2020 Jul;28(7):2325-2333. doi: 10.1007/s00167-019-05746-2. Epub 2019 Oct 30.

DOI:10.1007/s00167-019-05746-2

PMID:31667568

Abstract

PURPOSE

Glenoid bone loss contributes to recurrent instability after arthroscopic Bankart repair alone. With significant glenoid bone loss, better results have been reported after arthroscopic Bankart repair with glenoid arc reconstruction. However, no reports compare augmentation using bone graft with non-augmentation for glenoid bone loss. The purpose of this study was to assess clinical results of an arthroscopic Bankart repair with or without arthroscopic bone graft augmentation. It was hypothesized that such bone graft augmentation would restore shoulder stability, and lead to excellent outcomes.

METHODS

Of 552 patients treated for anterior glenohumeral instability with arthroscopic Bankart repair, 68 met this study's inclusion criteria of glenoid bone loss over 20% and follow-up of at least 2 years. Patients were divided into 2 groups based on whether with bone graft augmentation for glenoid bone loss [Group A: n = 35, median age; 21 years (range 13-72 years)], or not (Group B: n = 33, median age; 21 years (range 13-50 years)]. For grafting, either autologous iliac bone or artificial bone made of hydroxyapatite was used. Rowe score, recurrence rate, and return to sport were used to assess the results.

RESULTS

Mean Rowe score was 95.0 (SD 10.6) in Group A and 69.7 (SD 27.2) in Group B (p < 0.05). The recurrence rate was 2.9% (1/36) in Group A and 48.5% (16/33) in Group B (p < 0.05). Regarding contact/collision athletes, 24 were contained in Group A and 22 in Group B. Of the patients with recurrence in Group B, 13 (59.1%) were contact/collision athletes. Finally, 50% of the contact/collision sports athletes for both groups returned to their sports at the same as pre-injury level. Of the 11 patients who returned to the same level of contact/collision sports in Group B, seven returned with residual instability. Nine athletes in Group A and 3 in Group B quit their sports for personal or social reasons.

CONCLUSIONS

Bone graft augmentation was beneficial when used with Arthroscopic Bankart repair for recurrent anterior shoulder instability with glenoid bone loss. Especially, for recurrent anterior shoulder instability with glenoid bone loss in contact/collision sports athletes, bone graft augmentation should be strongly considered as beneficial.

LEVEL OF EVIDENCE

Level IV.

摘要

目的

关节镜下 Bankart 修复术单独治疗后，肩盂骨丢失会导致复发性不稳定。对于严重的肩盂骨丢失，关节镜下 Bankart 修复术联合肩盂弧形重建术可获得更好的效果。然而，目前尚无研究比较骨移植增强与非增强治疗肩盂骨丢失的效果。本研究旨在评估关节镜下 Bankart 修复术联合或不联合关节镜下骨移植增强治疗的临床效果。我们假设这种骨移植增强可以恢复肩关节稳定性，并带来良好的结果。

方法

对 552 例接受关节镜下 Bankart 修复术治疗的前肩盂不稳定患者进行回顾性研究，其中 68 例符合本研究的纳入标准，即肩盂骨丢失超过 20%，且随访时间至少 2 年。根据是否进行骨移植增强治疗肩盂骨丢失（A 组：n=35，中位年龄 21 岁（范围 13-72 岁）），将患者分为两组（B 组：n=33，中位年龄 21 岁（范围 13-50 岁））。对于植骨，使用自体髂骨或羟基磷灰石人工骨。采用 Rowe 评分、复发率和重返运动情况评估结果。

结果

A 组的平均 Rowe 评分为 95.0（标准差 10.6），B 组为 69.7（标准差 27.2）（p<0.05）。A 组的复发率为 2.9%（1/36），B 组为 48.5%（16/33）（p<0.05）。在接触/碰撞运动员中，A 组有 24 人，B 组有 22 人。在 B 组复发的患者中，有 13 人（59.1%）是接触/碰撞运动员。最后，两组中有 50%的接触/碰撞运动运动员恢复到受伤前的运动水平。在 B 组返回同一水平接触/碰撞运动的 11 名患者中，有 7 名患者仍存在残余不稳定。A 组有 9 名运动员和 B 组有 3 名运动员因个人或社会原因放弃运动。