Yildirim Kerem, Pehlivanoglu Tuna, Tandogan Reha N, Beyzadeoglu Tahsin
Department of Orthopaedics and Traumatology, Beyzadeoglu Clinic, Istanbul, Turkey.
School of Health Sciences, Yeni Yuzyil University, Istanbul, Turkey.
Orthop J Sports Med. 2022 May 24;10(5):23259671221098435. doi: 10.1177/23259671221098435. eCollection 2022 May.
Bilateral shoulder instability and Bankart lesions are not rare and frequently require surgical treatment. Bilateral instability may be treated with either a single-stage, simultaneous bilateral Bankart repair or 2-stage surgery.
PURPOSE/HYPOTHESIS: To compare simultaneous bilateral arthroscopic Bankart repair to 2-stage repair in terms of clinical outcomes and hospitalization costs. It was hypothesized that simultaneous repair would provide clinical outcomes similar to those of 2-stage Bankart repair while yielding lower hospitalization costs.
Cohort study; Level of evidence, 3.
Patients who underwent simultaneous bilateral arthroscopic Bankart repair (group 1) were matched by age, sex, and injury type to control patients who had unilateral Bankart repair (group 2). All patients were operated on by the same surgeon in the same institution between 2007 and 2017 and had a minimum follow-up duration of 24 months. Patients with inflammatory arthritis, metabolic/malignant disease, previous shoulder surgery, a glenoid bone loss ≥25%, or off-track Hill-Sachs lesion were excluded. The 2 groups were compared in terms of pre- and postoperative Western Ontario Shoulder Instability Index (WOSI) scores, hospitalization costs, complications, and recurrent instability. The hospitalization cost of group 2 was multiplied by 2 to create a projection of the estimated cost of 2 sequential unilateral Bankart repairs.
The study population comprised 48 patients (38 men [79.17%] and 10 women [20.83%]; mean age, 25.5 years at surgery and 22.75 years at first dislocation). Group 1 included 32 shoulders in 16 patients, while group 2 consisted of 32 shoulders in 32 patients. The mean hospitalization cost (in 2020 US dollars) was $26,010 ± $1455 for group 1 and $33,591 ± $1574 for group 2 ( < .001). Both groups had improved WOSI scores after surgery and achieved similar scores at the latest follow-up. There was 1 redislocation in each group (3.13%). No surgery- or anesthesia-related/medical complications were recorded in either group.
For bilateral shoulder instability, clinical outcomes of simultaneous bilateral arthroscopic Bankart repair were similar to those of 2-stage repair; however, lower hospitalization costs were seen after simultaneous bilateral repair compared with 2-stage surgery.
双侧肩关节不稳和Bankart损伤并不罕见，且常常需要手术治疗。双侧不稳可采用一期同时双侧Bankart修复术或二期手术治疗。
目的/假设：比较同期双侧关节镜下Bankart修复术与二期修复术的临床疗效和住院费用。假设同期修复术能提供与二期Bankart修复术相似的临床疗效，同时降低住院费用。
队列研究；证据等级，3级。
将接受同期双侧关节镜下Bankart修复术的患者（第1组），按照年龄、性别和损伤类型与接受单侧Bankart修复术的对照患者（第2组）进行匹配。所有患者均于2007年至2017年期间在同一机构由同一位外科医生进行手术，且最短随访时间为24个月。排除患有炎性关节炎、代谢/恶性疾病、既往肩部手术史、关节盂骨丢失≥25%或脱轨型Hill-Sachs损伤的患者。比较两组患者术前和术后的西安大略肩关节不稳指数（WOSI）评分、住院费用、并发症及复发性不稳情况。将第2组的住院费用乘以2，以推算连续两次单侧Bankart修复术的估计费用。
研究人群包括48例患者（38例男性[79.17%]和10例女性[20.83%]；手术时平均年龄25.5岁，首次脱位时平均年龄22.75岁）。第1组包括16例患者的32个肩关节，而第2组由32例患者的32个肩关节组成。第1组的平均住院费用（以2020年美元计）为26,010±1455美元，第2组为33,591±1574美元（P<.001）。两组患者术后WOSI评分均有所改善，且在最近一次随访时得分相似。每组均有1例再脱位（3.13%）。两组均未记录到与手术或麻醉相关的/医疗并发症。
对于双侧肩关节不稳，同期双侧关节镜下Bankart修复术的临床疗效与二期修复术相似；然而，与二期手术相比，同期双侧修复术后住院费用更低。
