关节镜下Bankart修复术后 remplissage 对6个月时力量和活动范围有何影响？一项多中心队列研究。
What Are the Effects of Remplissage on 6-Month Strength and Range of Motion After Arthroscopic Bankart Repair? A Multicenter Cohort Study.
作者信息
Frantz Travis L, Everhart Joshua S, Cvetanovich Gregory L, Neviaser Andrew, Jones Grant L, Hettrich Carolyn M, Wolf Brian R, Bishop Julie, Miller Bruce, Brophy Robert H, Ma C Benjamin, Cox Charlie L, Baumgarten Keith M, Feeley Brian T, Zhang Alan L, McCarty Eric C, Kuhn John E
机构信息
Investigation performed at The Ohio State University Wexner Medical Center, Department of Orthopaedics, Columbus, Ohio, USA.
出版信息
Orthop J Sports Med. 2020 Feb 27;8(2):2325967120903283. doi: 10.1177/2325967120903283. eCollection 2020 Feb.
BACKGROUND
Patients who have undergone shoulder instability surgery are often allowed to return to sports, work, and high-level activity based largely on a time-based criterion of 6 months postoperatively. However, some believe that advancing activity after surgery should be dependent on the return of strength and range of motion (ROM).
HYPOTHESIS
There will be a significant loss of strength or ROM at 6 months after arthroscopic Bankart repair with remplissage compared with Bankart repair alone.
STUDY DESIGN
Cohort study; Level of evidence, 2.
METHODS
A total of 38 patients in a prospective multicenter study underwent arthroscopic Bankart repair with remplissage (33 males, 5 females; mean age, 27.0 ± 10.2 years; 82% with ≥2 dislocation events in the past year). Strength and ROM were assessed preoperatively and at 6 months after surgery. Results were compared with 104 matched patients who had undergone Bankart repair without remplissage, although all had radiographic evidence of a Hill-Sachs defect.
RESULTS
At 6 months, there were no patients in the remplissage group with anterior apprehension on physical examination. However, 26% had a ≥20° external rotation (ER) deficit with the elbow at the side, 42% had a ≥20° ER deficit with the elbow at 90° of abduction, and 5% had persistent weakness. Compared with matched patients who underwent only arthroscopic Bankart repair, the remplissage group had greater humeral bone loss and had a greater likelihood of a ≥20° ER deficit with the elbow at 90° of abduction ( = .004). Risk factors for a ≥20° ER deficit with the elbow at 90° of abduction were preoperative stiffness in the same plane ( = .02), while risk factors for a ≥20° ER deficit with the elbow at the side were increased number of inferior quadrant glenoid anchors ( = .003), increased patient age ( = .02), and preoperative side-to-side deficits in ER ( = .04). The only risk factor for postoperative ER weakness was preoperative ER weakness ( = .04), with no association with remplissage ( = .26).
CONCLUSION
Arthroscopic Bankart repair with remplissage did not result in significant strength deficits but increased the risk of ER stiffness in abduction compared with Bankart repair without remplissage at short-term follow-up.
背景
接受肩部不稳定手术的患者通常在很大程度上基于术后6个月的时间标准被允许恢复运动、工作和进行高水平活动。然而，一些人认为术后活动的进展应取决于力量和活动范围（ROM）的恢复。
假设
与单纯Bankart修复相比，关节镜下Bankart修复并填充术后6个月时力量或ROM会有显著损失。
研究设计
队列研究；证据等级，2级。
方法
一项前瞻性多中心研究中的38例患者接受了关节镜下Bankart修复并填充（33例男性，5例女性；平均年龄27.0±10.2岁；82%在过去一年中有≥2次脱位事件）。术前及术后6个月评估力量和ROM。将结果与104例匹配的接受了无填充的Bankart修复的患者进行比较，尽管所有患者均有Hill-Sachs缺损的影像学证据。
结果
在6个月时，填充组中没有患者在体格检查时有前向恐惧。然而，26%的患者在肘部位于体侧时存在≥20°的外旋（ER）缺损，42%的患者在肘部外展90°时存在≥20°的ER缺损，5%的患者存在持续无力。与仅接受关节镜下Bankart修复的匹配患者相比，填充组有更大的肱骨骨质流失，且在肘部外展90°时出现≥20°ER缺损的可能性更大（P = .004）。肘部外展90°时出现≥20°ER缺损的危险因素是同一平面的术前僵硬（P = .02），而肘部位于体侧时出现≥20°ER缺损的危险因素是下象限盂唇锚钉数量增加（P = .003）、患者年龄增加（P = .02）以及术前ER的侧方差异（P = .04）。术后ER无力的唯一危险因素是术前ER无力（P = .04），与填充无关（P = .26）。
结论
在短期随访中，与无填充的Bankart修复相比，关节镜下Bankart修复并填充不会导致显著的力量缺损，但会增加外展时ER僵硬的风险。
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