关节镜下Bankart修复术与开放Latarjet手术治疗运动员复发性肩关节不稳的比较
Arthroscopic Bankart Repair Versus Open Latarjet for Recurrent Shoulder Instability in Athletes.
作者信息
Hurley Eoghan T, Davey Martin S, Montgomery Connor, O'Doherty Ross, Gaafar Mohamed, Pauzenberger Leo, Mullett Hannan
机构信息
Sports Surgery Clinic, Dublin, Ireland.
出版信息
Orthop J Sports Med. 2021 Sep 8;9(9):23259671211023801. doi: 10.1177/23259671211023801. eCollection 2021 Sep.
BACKGROUND
In athletes with recurrent shoulder instability, arthroscopic Bankart repair (ABR) and the open Latarjet procedure (OL) are commonly indicated to restore stability and allow them to return to play (RTP).
PURPOSE
To compare the outcomes of ABR and OL in athletes with recurrent shoulder instability.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
We performed a retrospective review of patients with recurrent shoulder instability who underwent ABR and OL and had a minimum 24-month follow-up. Indications for OL over ABR in this population were those considered at high risk for recurrence, including patients with glenohumeral bone loss. The patients were pair-matched in a 1:1 ratio (OL and ABR) by age, sex, sport, and level of preoperative play. We evaluated the rate, level, and timing of RTP, and the Shoulder Instability-Return to Sport after Injury (SIRSI) score between procedures. Additionally we compared the recurrence rate, visual analog scale (VAS) pain score, Subjective Shoulder Value (SSV), Rowe score, satisfaction, and whether patients would undergo the same surgery again.
RESULTS
Participants included 62 athletes who underwent ABR and 62 who underwent OL, with a mean follow-up of 47.7 months. There was no significant difference between ABR and OL in rate of RTP, return to preinjury level, time to return, SIRSI score, VAS score, SSV, or patient satisfaction. OL resulted in a significantly lower recurrence rate (1.6% vs 16.1% for ABR; = .009) and a significantly higher Rowe score (mean ± SD, 90.5 ± 12.2 vs 82.2 ± 20.8 for ABR; = .008). In collision athletes, there was no significant difference between ABR and OL regarding RTP rate (89.1% vs 94.5%; = .489) or SIRSI score (70.4 ± 24.8 vs 73.8 ± 19.6; = .426), but OL resulted in a lower recurrence rate (14.5% vs 1.8%; = .031).
CONCLUSION
ABR and OL resulted in excellent clinical outcomes, with high rates of RTP in athletes. However, lower recurrence rates were seen with OL.
背景
在复发性肩关节不稳的运动员中，关节镜下Bankart修复术（ABR）和开放Latarjet手术（OL）常用于恢复稳定性并使其能够重返赛场（RTP）。
目的
比较ABR和OL治疗复发性肩关节不稳运动员的疗效。
研究设计
队列研究；证据等级，3级。
方法
我们对接受ABR和OL且至少随访24个月的复发性肩关节不稳患者进行了回顾性研究。该人群中OL优于ABR的指征是那些被认为复发风险高的情况，包括存在盂肱关节骨质流失的患者。患者按年龄、性别、运动项目和术前运动水平以1:1的比例（OL和ABR）进行配对。我们评估了RTP的发生率、水平和时间，以及两种手术之间的损伤后肩关节不稳重返运动（SIRSI）评分。此外，我们比较了复发率、视觉模拟量表（VAS）疼痛评分、主观肩关节评分（SSV）、Rowe评分、满意度，以及患者是否会再次接受相同手术。
结果
参与者包括62例行ABR的运动员和62例行OL的运动员，平均随访47.7个月。ABR和OL在RTP发生率、恢复到伤前水平、恢复时间、SIRSI评分、VAS评分、SSV或患者满意度方面无显著差异。OL导致复发率显著降低（ABR为16.1%，OL为1.6%；P = 0.009），Rowe评分显著更高（ABR的平均值±标准差为82.2±20.8，OL为90.5±12.2；P = 0.008）。在碰撞项目运动员中，ABR和OL在RTP发生率（89.1%对94.5%；P = 0.489）或SIRSI评分（70.4±24.8对73.8±19.6；P = 0.426）方面无显著差异，但OL导致复发率更低（14.5%对1.8%；P = 0.031）。
结论
ABR和OL均产生了良好的临床疗效，运动员的RTP率较高。然而，OL的复发率更低。
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