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关节镜下Bankart修复术治疗伴有侵蚀型肩胛盂缺损的不稳定肩关节后的新骨形成。

New bone formation after arthroscopic Bankart repair for unstable shoulders with an erosion-type glenoid defect.

作者信息

Nakagawa Shigeto, Hirose Takehito, Ohori Tomoki, Yokoi Hiroyuki, Iuchi Ryo, Uchida Ryohei, Mae Tatsuo

机构信息

Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan.

Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Japan.

出版信息

J Shoulder Elbow Surg. 2023 Jan;32(1):9-16. doi: 10.1016/j.jse.2022.06.013. Epub 2022 Aug 2.

Abstract

BACKGROUND

The purpose of the present study was to retrospectively evaluate new bone formation after arthroscopic Bankart repair (ABR) and the influence of new bone formation on recurrence in shoulders with an erosion-type glenoid defect.

METHODS

We analyzed data on shoulders with an erosion-type glenoid defect. Participants were patients who underwent computed tomography to evaluate new bone formation after ABR performed from 2004 to 2021 and were followed for a minimum of 2 years. We investigated the factors influencing new bone formation, in particular the presence of an intraoperative bone fragment, and the influence of new bone formation and its size on postoperative recurrence.

RESULTS

A total of 100 shoulders were included. The mean glenoid defect size was 10.1% ± 6.3% (range, 1.2%-31.5%). New bone formed postoperatively in 15 shoulders (15.0%) and was seen in significantly more shoulders with an intraoperative bone fragment (11 of 18, 61.1%) than in those without a fragment (4 of 82, 4.9%; P < .001). Recurrence occurred in 22 shoulders (22.0%), and the rate of recurrence was not different between shoulders with new bone formation (3 of 15, 20.0%) and without new bone formation (19 of 85, 22.4%; P = .999). Among the 15 shoulders with new bone formation, the size of the new bone fragments relative to glenoid width was <5% in 2 shoulders, 5%-<7.5% in 8 shoulders, 7.5%-<10% in 3 shoulders, and ≥10% in 2 shoulders; in all 3 shoulders with postoperative recurrence, the relative size was <7.5%.

CONCLUSIONS

Even in shoulders with an erosion-type glenoid defect, new bone may form after ABR, especially in shoulders with an intraoperative bone fragment. However, new bone formation does not decrease the rate of postoperative recurrence.

摘要

背景

本研究的目的是回顾性评估关节镜下Bankart修复术(ABR)后新骨形成情况以及新骨形成对存在侵蚀型肩胛盂缺损的肩部复发的影响。

方法

我们分析了存在侵蚀型肩胛盂缺损的肩部数据。参与者为2004年至2021年接受ABR术后接受计算机断层扫描以评估新骨形成情况且随访至少2年的患者。我们调查了影响新骨形成的因素,特别是术中骨块的存在情况,以及新骨形成及其大小对术后复发的影响。

结果

共纳入100例肩部病例。肩胛盂缺损平均大小为10.1%±6.3%(范围为1.2% - 31.5%)。术后15例肩部(15.0%)形成了新骨,术中存在骨块的肩部出现新骨的比例(18例中的11例,61.1%)显著高于无骨块的肩部(82例中的4例,4.9%;P <.001)。22例肩部(22.0%)出现复发,有新骨形成的肩部(15例中的3例,20.0%)和无新骨形成的肩部(85例中的19例,22.4%)复发率无差异(P = 0.999)。在15例有新骨形成的肩部中,新骨块相对于肩胛盂宽度的大小,2例肩部<5%,8例肩部为5% - <7.5%,3例肩部为7.5% - <10%,2例肩部≥10%;在所有3例术后复发的肩部中,相对大小均<7.5%。

结论

即使在存在侵蚀型肩胛盂缺损的肩部,ABR术后也可能形成新骨,尤其是术中存在骨块的肩部。然而,新骨形成并不会降低术后复发率。

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