对于接受关节镜下Bankart修复的临界以下肩胛盂骨缺损患者，可考虑降低增加 remplissage手术的阈值。
Consideration May Be Given to Lowering the Threshold for the Addition of Remplissage in Patients With Subcritical Glenoid Bone Loss Undergoing Arthroscopic Bankart Repair.
作者信息
Horinek Jeffrey L, Menendez Mariano E, Callegari Jonathan J, Narbona Pablo, Lädermann Alexandre, Barth Johannes, Denard Patrick J
机构信息
Southern Oregon Orthopedics, Medford, Oregon, U.S.A.
Department of Shoulder and Elbow Surgery, Midwest Orthopedics at Rush, Chicago, Illinois, U.S.A.
出版信息
Arthrosc Sports Med Rehabil. 2022 Jun 4;4(4):e1283-e1289. doi: 10.1016/j.asmr.2022.04.004. eCollection 2022 Aug.
PURPOSE
Treatment for patients with anterior glenohumeral instability with subcritical bone loss is evolving. The purpose of this study was to compare 2-year outcomes of arthroscopic Bankart repair with and without Hill-Sachs remplissage in patients with <15% glenoid bone loss.
METHODS
A multicenter retrospective study was performed on a consecutive series of patients who underwent primary isolated arthroscopic Bankart repair (IBR) or arthroscopic Bankart repair with remplissage (REMP) by 4 shoulder specialists between 2013 and 2019. Range of motion (ROM) and patient-reported outcomes (PROs) were collected at baseline and 2 years postoperative: Western Ontario Shoulder Instability Index, Single Assessment Numeric Evaluation, and visual analog scale for pain. Recurrence, return to sport, satisfaction, complications, and revisions also were reviewed.
RESULTS
A total of 123 patients were available, including 75 IBR and 48 REMP. Baseline demographics, activity, ROM, and PROs were similar. Mean glenoid bone loss (2.5% vs 6.1%: < .001) was greater in REMP, although the number of on-track lesions was similar (98.7% vs 93.8%: = .298). WOSI scores were improved for REMP (196.5 vs 42.7: = .004), but otherwise no difference in postoperative PROs or ROM. Differences between cohorts did not reach significance in return to sport (73% vs 83%: = .203), recurrence (9.3% vs 2.1%: = .148), or revisions (6.8% vs 2.1%: = .403). For on-track lesions there were 6 recurrences in IBR (6 of 74; 8.1%) and 1 recurrence in REMP (1 of 45; 2.2%).
CONCLUSIONS
Despite slightly worse pathology, patients with subcritical bone loss who undergo REMP experience similar short-term postoperative function to isolated IBR. Recurrence, revision, and return to sport favored REMP but this study was underpowered to show statistical significance. Recurrence was common following IBR, despite subcritical glenoid bone loss and primarily on-track lesions, suggesting that REMP can be considered in on-track lesions.
LEVEL OF EVIDENCE
III, retrospective comparative study.
目的
对于存在临界以下骨质流失的肩盂前下方不稳患者，其治疗方法正在不断发展。本研究的目的是比较关节镜下Bankart修复术在有和没有Hill-Sachs充填术的情况下，对肩盂骨质流失小于15%的患者的2年治疗效果。
方法
对2013年至2019年间由4位肩部专家进行初次单纯关节镜下Bankart修复术（IBR）或关节镜下Bankart修复术联合充填术（REMP）的一系列连续患者进行多中心回顾性研究。在基线和术后2年收集活动范围（ROM）和患者报告的结果（PROs）：西安大略肩不稳指数、单项评估数字评价和疼痛视觉模拟量表。还对复发情况、恢复运动情况、满意度、并发症和翻修情况进行了评估。
结果
共有123例患者可供分析，其中75例行IBR，48例行REMP。基线人口统计学、活动情况、ROM和PROs相似。REMP组的平均肩盂骨质流失率更高（2.5%对6.1%：P<0.001），尽管轨迹良好的损伤数量相似（98.7%对93.8%：P = 0.298）。REMP组的WOSI评分有所改善（196.5对42.7：P = 0.004），但术后PROs或ROM在其他方面无差异。两组在恢复运动（73%对83%：P = 0.203）、复发（9.3%对2.1%：P = 0.148）或翻修（6.8%对2.1%：P = 0.403）方面的差异未达到显著水平。对于轨迹良好的损伤，IBR组有6例复发（74例中的6例；8.1%），REMP组有1例复发（45例中的1例；2.2%）。
结论
尽管病理情况稍差，但接受REMP的临界以下骨质流失患者术后短期功能与单纯IBR患者相似。复发、翻修和恢复运动方面REMP组更具优势，但本研究的样本量不足以显示统计学意义。IBR术后复发很常见，尽管肩盂骨质流失临界以下且主要为轨迹良好的损伤，这表明轨迹良好的损伤可考虑行REMP。
证据水平
III级，回顾性比较研究。
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