Tucker Allison, Ma Jie, Sparavalo Sara, Coady Catherine M, Wong Ivan
Division of Orthopaedic Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H 2E1, Canada.
Division of Orthopaedic Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H 2E1, Canada.
J ISAKOS. 2022 Oct;7(5):113-117. doi: 10.1016/j.jisako.2022.05.003. Epub 2022 May 29.
The primary purpose of this study was to determine the frequency and type of complications, including subluxation, infection, hardware complication, graft/glenoid fracture, chondrolysis, neurovascular deficits and stiffness following an Arthroscopic Bankart Repair (ABR) or an Arthroscopic Anatomic Glenoid Reconstruction (AAGR) using a distal tibia allograft for recurrent anterior shoulder instability. Secondary purposes were to determine the frank dislocation rate and the associations of post-operative complications with demographic patient factors.
Demographic and clinical data were reviewed using means ± standard deviations or frequencies in patients with recurrent anterior shoulder instability who underwent either an ABR or an AAGR. Post-operative patient records were analysed to identify any post-operative complications. The numerical variables of the two groups were compared using the independent t-test or Mann-Whitney U test. Categorical variables and complications were tested using the chi-square test, Fisher's exact test, or the two-sided Monte Carlo test with a significance level of 0.05.
We included 174 patients in this cohort, with 61.5% of patients receiving ABR and 38.5% receiving AAGR. Most of our patients were male (70.1%) with an average age of 23.41 ± 8.26 years in the ABR group and 29.37 ± 13.54 years in the AAGR group (p = 0.001). The two groups were similar with respect to their post-operative complication rates when excluding frank dislocation (ABR: 11%, AAGR: 12%). The AAGR group had statistically significantly higher rates of hardware removal compared to the ABR group (p = 0.004). The ABR group had 25 post-operative frank dislocations, with none reported in the AAGR cohort (p < 0.001). The total complication rate for each procedure was found to be 35% for ABR and 12% for AAGR.
AAGR has a comparable safety profile to the ABR when assessing post-operative complications such as subluxation, infection, graft/glenoid fracture, chondrolysis, neurovascular deficits and stiffness. AAGR is superior to ABR with respect to rates of recurrent instability and should be considered as a first-line treatment in certain patients with specific risk factors such as younger age, competitive contact sports participation, and higher number of instability events pre-operatively.
Level III.
本研究的主要目的是确定使用胫骨远端同种异体移植治疗复发性肩关节前脱位的关节镜下Bankart修复术（ABR）或关节镜下解剖型盂重建术（AAGR）后并发症的发生率和类型，包括半脱位、感染、内固定并发症、移植骨/肩胛盂骨折、关节软骨溶解、神经血管损伤和僵硬。次要目的是确定明显脱位率以及术后并发症与患者人口统计学因素之间的关联。
回顾性分析接受ABR或AAGR治疗的复发性肩关节前脱位患者的人口统计学和临床资料，采用均值±标准差或频率表示。分析术后患者记录以确定任何术后并发症。两组的数值变量采用独立t检验或Mann-Whitney U检验进行比较。分类变量和并发症采用卡方检验、Fisher精确检验或双侧蒙特卡洛检验，显著性水平为0.05。
本队列共纳入174例患者，其中61.5%接受ABR治疗，38.5%接受AAGR治疗。大多数患者为男性（70.1%），ABR组患者平均年龄为23.41±8.26岁，AAGR组为29.37±13.54岁（p = 0.001）。排除明显脱位后，两组术后并发症发生率相似（ABR：11%，AAGR：12%）。与ABR组相比，AAGR组内固定取出率在统计学上显著更高（p = 0.004）。ABR组术后有25例明显脱位，AAGR组未报告（p < 0.001）。发现ABR组和AAGR组各手术的总并发症发生率分别为35%和12%。
在评估术后并发症如半脱位、感染、移植骨/肩胛盂骨折、关节软骨溶解、神经血管损伤和僵硬时，AAGR与ABR具有相当的安全性。AAGR在复发性不稳定发生率方面优于ABR，对于某些具有特定风险因素的患者，如年龄较小、参加竞技性接触运动、术前不稳定事件较多等，应考虑将其作为一线治疗方法。
三级。
