iULS (Institut Universitaire Locomoteur & Sport), Hôpital Pasteur 2, Côte d'Azur University, Nice, France.
Department of Anaesthesiology, Hôpital Pasteur 2, Côte d'Azur University, Nice, France.
Bone Joint J. 2021 Apr;103-B(4):718-724. doi: 10.1302/0301-620X.103B4.BJJ-2019-0736.R2.
The aim of this study was to identify risk factors for recurrent instability of the shoulder and assess the ability to return to sport in patients with engaging Hill-Sachs lesions treated with arthroscopic Bankart repair and Hill-Sachs remplissage (ABR-HSR).
This retrospective study included 133 consecutive patients with a mean age of 30 years (14 to 69) who underwent ABR-HSR; 103 (77%) practiced sports before the instability of the shoulder. All had large/deep, engaging Hill-Sachs lesions (Calandra III). Patients were divided into two groups: A (n = 102) with minimal or no (< 10%) glenoid bone loss, and B (n = 31) with subcritical (10% to 20%) glenoid loss. A total of 19 patients (14%) had undergone a previous stabilization, which failed. The primary endpoint was recurrent instability, with a secondary outcome of the ability to return to sport.
At a mean follow-up of four years (1.0 to 8.25), ten patients (7.5%) had recurrent instability. Patients in group B had a significantly higher recurrence rate than those in group A (p = 0.001). Using a multivariate logistic regression, the presence of glenoid erosion of > 10% (odds ratio (OR) = 35.13 (95% confidence interval (CI) 8 to 149); p = 0.001) and age < 23 years (OR = 0.89 (0.79 to 0.99); p = 0.038) were associated with a higher risk of recurrent instability. A total of 80 patients (78%) could return to sport, but only 11 athletes (65%) who practiced high-risk (collision or contact-overhead) sports. All seven shoulders which were revised using a Latarjet procedure were stable at a mean final follow-up of 36 months (11 to 57) and returned to sports at the same level.
Patients with subcritical glenoid bone loss (> 10%) and younger age (≤ 23 years) are at risk of failure and reoperation after ABR-HSR. Furthermore, following this procedure, one-third of athletes practicing high-risk sports are unable to return at their pre-instability level, despite having a stable shoulder. Cite this article: 2021;103-B(4):718-724.
本研究旨在确定肩不稳复发的危险因素，并评估接受关节镜下 Bankart 修复和 Hill-Sachs 填充术（ABR-HSR）治疗的伴有 Hill-Sachs 撞击征的患者重返运动的能力。
本回顾性研究纳入了 133 例连续接受 ABR-HSR 治疗的平均年龄为 30 岁（14 至 69 岁）的患者，其中 103 例（77%）在肩不稳定前有运动史。所有患者均存在大/深的 Hill-Sachs 撞击征（Calandra III 型）。患者分为两组：A 组（n = 102），骨缺损< 10%（10%）；B 组（n = 31），骨缺损为临界性（10%至 20%）。共有 19 例（14%）患者曾行失败的初次稳定术。主要终点为复发性不稳定，次要终点为重返运动的能力。
平均随访 4 年（1.0 至 8.25 年），10 例（7.5%）患者出现复发性不稳定。B 组患者的复发率显著高于 A 组（p = 0.001）。多变量逻辑回归分析显示，> 10%的肩胛盂骨侵蚀（优势比（OR）= 35.13（95%置信区间（CI）8 至 149）；p = 0.001）和< 23 岁（OR = 0.89（0.79 至 0.99）；p = 0.038）与复发性不稳定的风险增加相关。80 例（78%）患者能够重返运动，但仅 11 例（65%）运动员（从事高风险（碰撞或接触性过头）运动）重返运动。7 例接受 Latarjet 手术翻修的患者在平均 36 个月（11 至 57 个月）的最终随访中均稳定，且能够重返相同运动水平。
ABR-HSR 治疗后，存在临界性骨缺损（> 10%）和年轻（≤ 23 岁）的患者存在失败和再次手术的风险。此外，尽管患者的肩部稳定，但三分之一从事高风险运动的运动员无法恢复到不稳定前的运动水平。
