开放性Bankart修复加下囊移位与Latarjet手术治疗复发性前肩不稳的接触性运动员的疗效比较。
Outcomes of Open Bankart Repair Plus Inferior Capsular Shift Compared with Latarjet Procedure in Contact Athletes with Recurrent Anterior Shoulder Instability.
作者信息
Bitar Ivan Jose, Bustos Damian Gabriel, Marangoni Lucas Daniel, Robles Cristian, Gentile Luciano, Bertiche Pablo
机构信息
Sanatorio Allende, Cordoba, Argentina.
出版信息
Arch Bone Jt Surg. 2023;11(1):39-46. doi: 10.22038/ABJS.2022.60208.2974.
BACKGROUND
Open Bankart repair plus inferior capsular shift (OBICS) and Latarjet procedure (LA) are considered appropriate treatment alternatives for high-performance athletes. The purpose of this study was to evaluate the functional outcomes and recurrence rate of each surgery. Our hypothesis: there were no differences between the two treatments.
METHODS
A prospective cohort study was conducted with n=90 contact athletes divided into two groups of 45 patients. One group was treated with OBICS, and the other one with LA. The mean follow-up period was 25 (24-32) months for the OBICS group and 26 (24-31) months for the LA group. Primary functional outcomes of each group were assessed at baseline, six months, one year, and two years after surgery. The functional outcomes were also compared between the groups. The evaluation tools used were the Western Ontario Shoulder Instability score (WOSI) and the American Shoulder and Elbow Surgeons scale (ASES). In addition, recurrent instability and range of motion (ROM) were also evaluated.
RESULTS
In each group, significant changes were found in the WOSI score and ASES scale from pre-op to postop. However, there were no significant differences between the functional outcomes of the groups at the final follow-up (P-values 0.73 and 0.19). Three dislocations and one subluxation (8.8%) were reported in the OBICS group, and three subluxations were reported in the LA group (6.6%), revealing no significant differences between the groups (). Moreover, there were no significant differences between preoperative and postoperative ROM in each group or in terms of external rotation (ER) and ER in 90º abduction between the groups.
CONCLUSION
No differences were found between OBICS and LA surgery. Both procedures can be indicated according to the surgeon's preference to reduce recurrence rates in contact athletes with recurrent anterior shoulder instability.
背景
开放性Bankart修复术加关节囊下移位术（OBICS）和Latarjet手术（LA）被认为是高性能运动员的合适治疗选择。本研究的目的是评估每种手术的功能结果和复发率。我们的假设：两种治疗方法之间没有差异。
方法
对90名接触性运动员进行了一项前瞻性队列研究，分为两组，每组45例患者。一组接受OBICS治疗，另一组接受LA治疗。OBICS组的平均随访期为25（24 - 32）个月，LA组为26（24 - 31）个月。在基线、术后6个月、1年和2年评估每组的主要功能结果。还对两组之间的功能结果进行了比较。使用的评估工具是西 Ontario 肩部不稳定评分（WOSI）和美国肩肘外科医生量表（ASES）。此外，还评估了复发性不稳定和活动范围（ROM）。
结果
在每组中，从术前到术后，WOSI评分和ASES量表均有显著变化。然而，在最终随访时，两组的功能结果之间没有显著差异（P值分别为0.73和0.19）。OBICS组报告了3例脱位和1例半脱位（8.8%），LA组报告了3例半脱位（6.6%），两组之间无显著差异（）。此外，每组术前和术后的ROM之间或两组之间在90°外展时的外旋（ER）方面均无显著差异。
结论
OBICS和LA手术之间没有差异。两种手术均可根据外科医生的偏好选择，以降低复发性前肩不稳定的接触性运动员中的复发率。
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