Kelly Ann Marie, Kelly John D
Lebanon, New Hampshire; Philadelphia, Pennsylvania, U.S.A.
Arthroscopy. 2023 Mar;39(3):703-705. doi: 10.1016/j.arthro.2022.11.010.
In patients with on-track shoulder Hill-Sachs lesions, the addition of remplissage using a double-pulley technique to Bankart repair improves outcomes including residual apprehension and without loss of external rotation. A caveat is that measurement of both the Hill-Sachs lesion and glenoid bone loss may be inconsistent. A second caveat is that determination of the glenoid track can be affected by scapular positioning. Not all "on-track" lesions are alike. In terms of outcome assessment, apprehension has up to 95% specificity for anterior shoulder instability and is a key finding in determining the results of shoulder stabilization. Recurrent instability may not be as sensitive of an outcome measure, because patients will avoid positions of apprehension. Finally, remplissage should be used cautiously in peripheral track lesions. For smaller Hill-Sachs lesions, remplissage can provide extraordinary success, and for larger lesions that are close to engaging, glenoid bone loss must also be treated, especially in a younger, active patient.
在患有符合轨迹的肩关节希尔-萨克斯损伤的患者中，采用双滑车技术进行充填术并联合Bankart修复术可改善治疗效果，包括残余恐惧症状，且不会导致外旋丧失。需要注意的是，希尔-萨克斯损伤和肩胛盂骨缺损的测量可能不一致。另一个需要注意的是，肩胛盂轨迹的确定可能会受到肩胛骨位置的影响。并非所有“符合轨迹”的损伤都是相同的。在结果评估方面，恐惧症状对肩关节前向不稳的特异性高达95%，是确定肩关节稳定手术效果的关键发现。复发性不稳作为一种结果指标可能不那么敏感，因为患者会避免引起恐惧的姿势。最后，在外周轨迹损伤中应谨慎使用充填术。对于较小的希尔-萨克斯损伤，充填术可能会取得显著成功，而对于接近嵌顿的较大损伤，还必须治疗肩胛盂骨缺损，尤其是对于年轻、活跃的患者。
