Mohd Nasir Mohd Nizlan, Hussin Paisal, Dieu Kiat Raymond Yeak, Abdul Kahar Johan
Sports Surgery Division, Universiti Putra Malaysia, Serdang, MYS.
Orthopaedics, Columbia Asia Hospital, Puchong, MYS.
Cureus. 2023 May 31;15(5):e39811. doi: 10.7759/cureus.39811. eCollection 2023 May.
Management of shoulder dislocation can be challenging especially when glenoid bone fracture is involved. Bony Bankart lesion can be managed either through an open surgery or, of late, using arthroscopic technique. Arthroscopic bony Bankart repair is technically difficult, requiring specialized instruments to penetrate the bone fragment within the detached labrum. This case report describes an alternative way of doing an arthroscopic reattachment of an acute bony Bankart lesion using traction sutures, an accessory anteromedial portal and utilization of knotless anchors. A 44-year-old male technician was climbing a ladder when he slipped and fell directly on his left shoulder. Imaging revealed bony Bankart fracture with presence of ipsilateral greater tuberosity (GT) fracture and a Hill-Sachs lesion. In a right lateral position, arthroscopic reduction of the bony fragment was performed utilizing a Fibrewire® (Arthrex, Inc., Naples, FL, USA) suture as traction apparatus while securing the upper and lower tissue enveloping the bony Bankart fragment. An accessory portal was made lower down anteriorly to de-rotate the fragment, holding it in place while securing two Pushlock® (Arthrex, Inc.) anchors to the native glenoid. We then performed GT fixation using two cannulated screws. Check radiographs revealed acceptable reduction of the Bankart fragment. With careful case selection, arthroscopic repair of acute bony Bankart lesions is possible using special arthroscopic reduction maneuver and fixation technique with subsequent good outcome.
肩关节脱位的处理颇具挑战性，尤其是合并肩胛盂骨折时。骨性Bankart损伤可通过开放手术治疗，近年来也可采用关节镜技术。关节镜下骨性Bankart修复技术难度大，需要专用器械穿透分离盂唇内的骨块。本病例报告描述了一种使用牵引缝线、辅助前内侧入路和无结锚钉进行关节镜下急性骨性Bankart损伤重新固定的替代方法。一名44岁男性技术员在爬梯子时滑倒，直接摔倒在左肩上。影像学检查显示为骨性Bankart骨折，伴有同侧大结节（GT）骨折和Hill-Sachs损伤。患者取右侧卧位，利用Fibrewire®（美国佛罗里达州那不勒斯市Arthrex公司）缝线作为牵引装置进行关节镜下骨块复位，同时固定包裹骨性Bankart骨块的上下组织包膜。在前下方做一个辅助入路以旋转骨块，将其固定到位，同时将两个Pushlock®（Arthrex公司）锚钉固定到肩胛盂上。然后我们使用两枚空心螺钉进行GT固定。复查X线片显示Bankart骨块复位良好。通过仔细的病例选择，采用特殊的关节镜复位手法和固定技术，急性骨性Bankart损伤的关节镜修复是可行的，且随后效果良好。
