青少年开放式 Latarjet 手术和关节镜 Bankart 修复的长期结果和失败分析。
Long-Term Results and Failure Analysis of the Open Latarjet Procedure and Arthroscopic Bankart Repair in Adolescents.
机构信息
Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
出版信息
J Bone Joint Surg Am. 2022 Jun 15;104(12):1046-1054. doi: 10.2106/JBJS.21.01050. Epub 2022 Apr 22.
BACKGROUND
The purpose of this study was to analyze the long-term results of arthroscopic Bankart repair compared with an open Latarjet procedure in adolescents who are at high risk for recurrent anterior shoulder instability. We hypothesized that the long-term stability rate of an open Latarjet procedure would be superior to that of arthroscopic Bankart repair.
METHODS
Forty eligible patients (41 shoulders) with a mean age of 16.4 years (range, 13 to 18 years) underwent arthroscopic Bankart repair, and 37 patients (40 shoulders) with a mean age of 16.7 years (range, 14 to 18 years) underwent an open Latarjet procedure. Of these, 34 patients (35 shoulders) in the Bankart group and 30 patients (31 shoulders) in the Latarjet group with long-term follow-up were compared; the overall follow-up rate was 82%. Clinical and radiographic results were obtained after a mean follow-up of 12.2 years (range, 8 to 18 years).
RESULTS
Treatment failure occurred in 20 shoulders (57%) in the Bankart repair group and in 2 shoulders (6%) in the open Latarjet procedure group (p < 0.001), representing a significantly higher revision rate for instability in the Bankart group (13) compared with the Latarjet group (1) (p < 0.001). In patients without recurrent shoulder instability (15 in the Bankart group and 29 in the Latarjet group), there was a significant improvement in the Constant score (p = 0.006 in the Bankart group and p < 0.001 in the Latarjet group) and Subjective Shoulder Value (p = 0.009 in the Bankart group and p < 0.001 in the Latarjet group), without any significant difference between the 2 groups. Younger age was the only variable significantly correlated with failure following a Bankart repair (p = 0.01).
CONCLUSIONS
Adolescents are at a high risk for treatment failure after Bankart repair, and, therefore, the Latarjet procedure should be strongly considered as a primary procedure for recurrent anterior shoulder instability in this population.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景
本研究旨在分析关节镜下 Bankart 修复术与开放式 Latarjet 手术治疗高危复发性肩关节前不稳定的青少年患者的长期结果。我们假设开放式 Latarjet 手术的长期稳定性优于关节镜下 Bankart 修复术。
方法
40 例符合条件的患者（41 肩），平均年龄 16.4 岁（范围，13 至 18 岁）行关节镜下 Bankart 修复术，37 例（40 肩）平均年龄 16.7 岁（范围，14 至 18 岁）行开放式 Latarjet 手术。其中 Bankart 组 34 例（35 肩），Latarjet 组 30 例（31 肩）患者获得长期随访，总体随访率为 82%。平均随访 12.2 年（范围，8 至 18 年）后获得临床和影像学结果。
结果
Bankart 修复组 20 肩（57%）和开放式 Latarjet 组 2 肩（6%）（p<0.001）治疗失败，Bankart 组（13 例）不稳定再手术率显著高于 Latarjet 组（1 例）（p<0.001）。在无复发性肩关节不稳定的患者中（Bankart 组 15 例，Latarjet 组 29 例），Constant 评分显著改善（Bankart 组 p=0.006，Latarjet 组 p<0.001），主观肩价值评分显著改善（Bankart 组 p=0.009，Latarjet 组 p<0.001），两组间无显著差异。年龄较小是 Bankart 修复术后失败的唯一显著相关变量（p=0.01）。
结论
青少年行 Bankart 修复术后发生治疗失败的风险较高，因此对于该人群复发性肩关节前不稳定，Latarjet 手术应作为首选治疗方案。
证据水平
治疗性 III 级。有关完整的证据等级说明，请参见作者指南。
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