Paris Shoulder Unit, Institut de La Main Clinique Bizet, 21 bis rue Georges Bizet, 75116, Paris, France.
Hospital Fundación Jiménez Diaz, Avenida de los Reyes Católicos 2, 28040, Madrid, Spain.
Eur J Orthop Surg Traumatol. 2023 May;33(4):947-953. doi: 10.1007/s00590-022-03237-8. Epub 2022 Feb 28.
To evaluate long-term results after arthroscopic Bankart repair and Hill-Sachs remplissage (BHSR) in bipolar bone defects with less than 20% of glenoid bone loss (GBL) and to analyse risk factors for recurrent dislocation.
From 2009-2012, 43 patients with recurrent anterior shoulder instability were treated with BHSR. Inclusion criteria were GBL < 20% and minimum of 4-yearfollow-up. There were 35 males and 8 females with a mean age of 29 years (range 16-53). The mean ISIS score was 3.6 (range 2-6). Patients were evaluated for recurrence, range of motion and functional outcomes (Walch-Duplay and Rowe score). Post-operative MRI was performed at least 6 months after surgery to evaluate infraspinatus capsulotenodesis healing. Glenoid track was assessed retrospectively from pre-operative computed tomography. Mean follow-up was 7.3 years (range 4-11).
At the last follow-up, good to excellent outcomes were reported in 86% of patients. Average post-operative Walch-Duplay was 87.9 (range 75-100) and ROWE 93.7 (range 70-100). Infraspinatus capsulotenodesis healing was achieved in 86%. The rate of recurrence and revision surgery was 9.3% and 13.9%, respectively. Recurrence was associated with higher ISIS score (p = 0.0191) and lower age at surgery (p = 0.0227). Four (9.3%) Hill-Sachs lesions were considered off-track. The presence of off-track Hill-Sachs was associated with higher risk of recurrence (p < 0.00001).
Arthroscopic BHSR improves shoulder instability in the setting of bipolar bone defects with less than 20% of GBL. Patient-related factors and pre-operative glenoid track should be taken into consideration to reduce the risk of recurrence.
评估肱骨头骨缺损小于 20%（即肩胛盂骨缺损小于 20%）且经关节镜 Bankart 修复术联合 Hill-Sachs 填充术（BHSR）治疗的复发性肩关节前向不稳定患者的长期疗效，并分析复发性肩关节前向不稳定的相关危险因素。
2009 年至 2012 年，对 43 例肱骨头骨缺损小于 20%且经关节镜 Bankart 修复术联合 Hill-Sachs 填充术治疗的复发性肩关节前向不稳定患者进行了回顾性研究。纳入标准：肩胛盂骨缺损小于 20%，随访时间至少 4 年。男 35 例，女 8 例；年龄 1653 岁，平均 29 岁；国际肩关节评分（ISIS）平均 3.6 分（26 分）。通过评估复发性肩关节前向不稳定、肩关节活动度和肩关节功能（Walch-Duplay 评分和 Rowe 评分）来评价疗效。所有患者术后至少 6 个月进行 MRI 检查，评估冈下肌肌腱止点骨融合愈合情况。采用术前 CT 对肩胛盂轨迹进行回顾性评估。平均随访时间为 7.3 年（4~11 年）。
末次随访时，86%的患者疗效优良。术后平均 Walch-Duplay 评分为 87.9 分（75100 分），Rowe 评分为 93.7 分（70100 分）。术后 86%的患者冈下肌肌腱止点骨融合愈合。肩关节复发和翻修手术的发生率分别为 9.3%和 13.9%。ISIS 评分较高（p=0.0191）和手术时年龄较小（p=0.0227）与肩关节复发相关。4 例（9.3%）Hill-Sachs 病变被认为不在关节盂轨迹内。Hill-Sachs 病变不在关节盂轨迹内与肩关节复发风险增加显著相关（p<0.00001）。
关节镜下 Bankart 修复术联合 Hill-Sachs 填充术可改善肱骨头骨缺损小于 20%且经关节镜 Bankart 修复术联合 Hill-Sachs 填充术治疗的复发性肩关节前向不稳定患者的肩关节稳定性。患者相关因素和术前肩胛盂轨迹应作为评估复发风险的参考因素。
