Zhang Chunsen, Pang Long, Xiong Yan, Li Qi, Chen Gang, Li Jian, Tang Xin
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 May 15;37(5):545-550. doi: 10.7507/1002-1892.202304003.
To investigate the mid-term effectiveness of arthroscopic Bankart repair for recurrent anterior shoulder dislocation.
The clinical data of 107 patients with recurrent anterior shoulder dislocation who met the inclusion criteria between January 2017 and June 2021 was retrospectively analyzed, and all patients underwent arthroscopic Bankart repair. There were 88 males and 19 females. The age of the primary dislocation ranged from 13 to 48 years (mean, 23.3 years). The number of preoperative dislocations was 2-160 times (median, 7 times). The duration of preoperative instability was 0.2-240.0 months (median, 36.0 months). The mean age at operation was 28.2 years (range, 16-61 years). There were 43 cases of left shoulder and 64 cases of right shoulder. The proportion of glenoid defects in 63 patients was 1.7%-16.1% (mean, 8.1%). MRI showed that none of the patients had rotator cuff tears or shoulder stiffness. The CT three-dimensional reconstruction was performed at 1 day after operation to evaluate the distribution of implanted anchors and the occurrence of glenoid split fracture and whether there were nails pullout at the implant site. The postoperative complications were observed, and the pain and function of the shoulder were evaluated by visual analogue scale (VAS) score, Rowe score, Constant-Murley score, and American Shoulder and Elbow Surgeons (ASES) score. The recurrence of instability, the results of apprehension test, the number of patients who returned to preoperative sports level, and the satisfaction rate of patients were recorded.
All patients were successfully operated and were followed up 20-73 months (mean, 41.5 months). All incisions healed by first intention. The CT three-dimensional reconstruction at 1 day after operation showed that the anchors were located at the 2 : 00-5 : 30 positions of the glenoid, and there was no glenoid split fracture or nails pullout at the implant site. At last follow-up, VAS score was significantly lower than that before operation, and Rowe score, Constant-Murley score, and ASES score were significantly higher than those before operation ( <0.05). Seven patients (6.5%) had recurrence of anterior shoulder dislocation at 23-55 months (mean, 39.9 months) after operation, including 6 cases of dislocation and 1 case of subluxation. At last follow-up, 51 patients (47.7%) returned to preoperative sports level, and 11 patients (10.3%) had a positive apprehension test. The patients' satisfaction rate was 90.7% (97/107). Among the 10 patients who were not satisfied with the surgical effectiveness, 7 patients had postoperative recurrence of instability, and 3 patients felt that they did not return to preoperative sports level.
Arthroscopic Bankart repair has good mid-term effectiveness in patients with recurrent anterior shoulder dislocations, minimal or no glenohumeral bone defects and low sports need.
探讨关节镜下Bankart修复术治疗复发性肩关节前脱位的中期疗效。
回顾性分析2017年1月至2021年6月期间符合纳入标准的107例复发性肩关节前脱位患者的临床资料，所有患者均接受关节镜下Bankart修复术。其中男性88例，女性19例。初次脱位年龄为13至48岁（平均23.3岁）。术前脱位次数为2至160次（中位数为7次）。术前不稳定持续时间为0.2至240.0个月（中位数为36.0个月）。平均手术年龄为28.2岁（范围为16至61岁）。左肩43例，右肩64例。63例患者的关节盂缺损比例为1.7%至16.1%（平均8.1%）。MRI显示所有患者均无肩袖撕裂或肩关节僵硬。术后第1天进行CT三维重建，评估植入锚钉的分布、关节盂劈裂骨折的发生情况以及植入部位是否有钉子拔出。观察术后并发症，采用视觉模拟评分法（VAS）、Rowe评分、Constant-Murley评分和美国肩肘外科医师（ASES）评分评估肩部疼痛和功能。记录不稳定复发情况、恐惧试验结果、恢复到术前运动水平的患者数量以及患者满意度。
所有患者手术均成功，随访20至73个月（平均41.5个月）。所有切口均一期愈合。术后第1天的CT三维重建显示，锚钉位于关节盂的2:00至5:30位置，植入部位无关节盂劈裂骨折或钉子拔出。末次随访时，VAS评分显著低于术前，Rowe评分、Constant-Murley评分和ASES评分显著高于术前（<0.05）。7例患者（6.5%）在术后23至55个月（平均39.9个月）出现肩关节前脱位复发，其中脱位6例，半脱位1例。末次随访时，51例患者（47.7%）恢复到术前运动水平，11例患者（10.3%）恐惧试验阳性。患者满意度为90.7%（97/107）。在对手术效果不满意的10例患者中，7例患者术后出现不稳定复发，3例患者感觉未恢复到术前运动水平。
关节镜下Bankart修复术治疗复发性肩关节前脱位中期疗效良好，肱盂骨缺损极少或无，且运动需求较低。
