单纯行 Bankart 修复术与 Bankart 修复术联合 Remplissage 术治疗时，将“未卡压”的 Hill-Sachs 损伤错误分类为“非卡压”是否会影响疗效？
Does an "Off-Track" Hill-Sachs Lesion That Is Misclassified as "Non-Engaging" Affect Outcomes From Bankart Repair Alone Compared With Bankart Repair Combined With Remplissage?
机构信息
Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
出版信息
Arthroscopy. 2021 Feb;37(2):450-456. doi: 10.1016/j.arthro.2020.09.037. Epub 2020 Sep 29.
PURPOSE
To determine how intraoperative assessment (engagement test) may affect recurrent dislocation rate and to compare the clinical outcomes, recurrence rates, and presence of on-/off-track conditions between cases that received arthroscopic Bankart repair alone (nonengaged Hill-Sachs lesion) and Bankart repair with remplissage (engaged Hill-Sachs lesion).
METHODS
We retrospectively reviewed 213 patients who underwent arthroscopic Bankart repair alone (186 patients with nonengaging lesions, group A) or with remplissage (27 patients with engaging lesion, group B) for recurrent anterior shoulder instability with <25% glenoid bone defect. The presence of an engaging Hill-Sachs lesion was determined during arthroscopic evaluation. On-track or off-track lesions were assessed retrospectively from preoperative 3-dimensional (3D) computed tomography (CT).
RESULTS
Mean glenoid bone defect was 13.7% in group A and 20.7% in group B (P < .001). Off-track lesions were identified in 8.1% (15/186) and 100% (27/27) in group B. At the final follow-up (minimum 2 years; mean follow-up periods after surgery of 50.1 months in group A and 47.7 months in group B), there were no significant differences in shoulder functional scores and recurrence rates between groups, despite improvement after surgery. In the off-track lesion (group A-1: nonengaging but off-track lesion), recurrence instability occurred in 9 patients (60%, 9/15). Also, comparing group A-1 and group B, we noted significant differences in shoulder functional scores and recurrence rates (P < .001).
CONCLUSION
Of 186 patients, 8.1% with nonengaging Hill-Sachs lesions during direct arthroscopic examination under anesthesia actually demonstrated off-track lesions on preoperative 3D CT scans retrospectively, with 60% experiencing recurrent instability. Intraoperative manual assessment for Hill-Sachs engagement was inferior to 3D CT scan in establishing the presence of off-track defects.
LEVEL OF EVIDENCE
III, retrospective comparative study.
目的
确定术中评估（啮合试验）如何影响复发性脱位率，并比较单独行关节镜 Bankart 修复（无啮合 Hill-Sachs 病变）与 Bankart 修复加填充术（啮合 Hill-Sachs 病变）的病例的临床结果、复发率和有无脱轨/过轨情况。
方法
我们回顾性分析了 213 例因复发性前肩不稳定接受关节镜 Bankart 修复的患者，其中 186 例（无啮合病变，A 组）和 27 例（啮合病变，B 组）接受关节镜 Bankart 修复，骨缺损<25%。术中评估确定是否存在啮合 Hill-Sachs 病变。术前 3 维（3D）CT 回顾性评估有无过轨或脱轨病变。
结果
A 组平均盂骨缺损为 13.7%，B 组为 20.7%（P<0.001）。B 组中有 100%（27/27）的病例存在过轨病变，而 A 组中有 8.1%（15/186）的病例存在过轨病变。末次随访（至少 2 年；A 组术后平均随访时间为 50.1 个月，B 组为 47.7 个月），尽管手术后有所改善，但两组间肩关节功能评分和复发率无显著差异。在脱轨病变（A 组-1：无啮合但脱轨病变）中，9 例（60%，9/15）患者出现复发性不稳定。此外，比较 A 组-1 和 B 组，我们发现肩关节功能评分和复发率存在显著差异（P<0.001）。
结论
在直接关节镜检查下，186 例患者中，8.1%的患者术中表现为无啮合 Hill-Sachs 病变，但实际上在术前 3D CT 扫描上存在过轨病变，其中 60%的患者出现复发性不稳定。术中手动评估 Hill-Sachs 啮合情况在确定脱轨缺陷方面不如 3D CT 扫描。
证据等级
III，回顾性比较研究。
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