Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii.
Uniformed Services University, Bethesda, Maryland.
J Bone Joint Surg Am. 2023 Nov 15;105(22):1815-1821. doi: 10.2106/JBJS.23.00388. Epub 2023 Aug 29.
Glenoid bone loss has been reported to occur in as many as 86% of patients with recurrent shoulder stability. This systematic review evaluated the amount of glenoid bone loss associated with recurrent shoulder dislocation or subluxation and with worse patient-reported outcomes after arthroscopic Bankart repair. We hypothesized that the percentage of glenoid bone loss associated with recurrent instability after arthroscopic Bankart repair is lower than the previously proposed critical value of 25%.
The systematic review included 528 patients with glenoid bone loss from 3 clinical studies. The percentage of bone loss was the value quantified and reported in each study. Failure was defined as recurrent dislocation or subluxation. The percentage of glenoid bone loss associated with recurrent shoulder dislocation or subluxation after arthroscopic Bankart labral repair was analyzed with receiver operating characteristic (ROC) curve analysis.
Recurrent dislocation or subluxation occurred in 23.7% (125) of 528 patients in the pooled study cohort. There was a significant difference in age between those in whom the arthroscopic Bankart repair failed and those in whom it did not (22.9 versus 24.3 years; p = 0.009). The ROC curve analysis demonstrated that ≥16.0% glenoid bone loss was predictive of recurrent shoulder dislocation or subluxation (Youden index = 0.59, sensitivity = 80%, specificity = 80%). In patients who did not sustain a recurrent dislocation or subluxation, the ROC curve analysis demonstrated that 20.0% glenoid bone loss was predictive of a Single Assessment Numeric Evaluation (SANE) score of <85% (Youden index = 0.93, sensitivity = 93%, specificity = 100%).
The critical amount of glenoid bone loss associated with an increased risk of persistent instability was found to be less than previously reported. Glenoid bone loss of ≥16.0% was found to place patients at higher risk for recurrent shoulder dislocation or subluxation after treatment with arthroscopic Bankart repair alone.
Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
据报道，在多达 86%的复发性肩稳定性患者中会出现肩盂骨丢失。本系统评价评估了与复发性肩关节脱位或半脱位以及关节镜下 Bankart 修复后患者报告结局较差相关的肩盂骨丢失量。我们假设，与关节镜下 Bankart 修复后复发性不稳定相关的肩盂骨丢失百分比低于先前提出的 25%的临界值。
该系统评价纳入了 3 项临床研究中 528 例有肩盂骨丢失的患者。每个研究都量化和报告了骨丢失的百分比。失败定义为复发性脱位或半脱位。通过接收者操作特征 (ROC) 曲线分析，分析关节镜下 Bankart 盂唇修复后与复发性肩关节脱位或半脱位相关的肩盂骨丢失百分比。
在汇总研究队列中，23.7%（125 例）的 528 例患者发生复发性脱位或半脱位。关节镜下 Bankart 修复失败和未失败的患者之间的年龄存在显著差异（22.9 岁比 24.3 岁；p = 0.009）。ROC 曲线分析表明，≥16.0%的肩盂骨丢失与复发性肩关节脱位或半脱位相关（约登指数=0.59，敏感性=80%，特异性=80%）。在未发生复发性脱位或半脱位的患者中，ROC 曲线分析表明，20.0%的肩盂骨丢失与单一评估数字评估（SANE）评分<85%相关（约登指数=0.93，敏感性=93%，特异性=100%）。
发现与持续性不稳定风险增加相关的临界肩盂骨丢失量小于先前报道的量。单独行关节镜下 Bankart 修复后，肩盂骨丢失≥16.0%的患者发生复发性肩关节脱位或半脱位的风险更高。
治疗性 IV 级。请参阅作者说明，以获得完整的证据水平描述。
