Samant Vinay, Wade Roshan
Department of Orthopaedics, H.B.T. Medical College, R.N. Cooper Hospital, India.
Seth G.S. Medical College, King Edward Memorial Hospital Mumbai, India.
J Orthop. 2023 Oct 14;46:1-6. doi: 10.1016/j.jor.2023.10.005. eCollection 2023 Dec.
Introduction- Subscapularis augmented Bankart repair (SB) is a novel arthroscopic technique of tenodesis of upper 1/3rd fibers of subscapularis tendon to capsulo-labral repair of Bankart lesion. Treatment of Bony Bankart lesion with glenoid bone loss % (GBL%) 10%-20 % is still a grey zone where bone augmentation procedures are an overtreatment and capsulo-labral repair is associated with high recurrence.
A retrospective study of 30 patients with h/o anterior instability with GBL%<20 % were classified into two groups. SB group included patients managed with arthroscopic subscapularis augmentation while CB group included patients managed with arthroscopic capsulo-labral repair. These patients were followed up after a minimum of 24 months post-surgery and functional outcomes evaluated using WOSI, ASES and ROWE scores.
Patients in the SB group showed superior functional outcomes for WOSI and ROWE scores. Considering postoperative shoulder pain, the median ROWE-P (pain) score was better for SB group (10/10) when compared to CB group (5/10). Patients under SB group were more comfortable with physical symptoms of their shoulder (WOSI-P average 60/1000) and were more likely to continue their recreational sports activity (WOSI- sports for SB 63.7 and CB 119.5. In our study, none of the 15 SB patients had any restriction in range of shoulder movements [ROWE-M score of 10]. Subscapularis augmented Bankart repair is associated with minimal restriction of shoulder range, better pain relief, better acceptability and smoother return to daily living and occupation and can be considered as a routine for every patient with GBL<20 %.
引言 - 肩胛下肌增强Bankart修复术（SB）是一种将肩胛下肌腱上1/3纤维进行腱固定术以修复Bankart损伤的关节盂唇修复的新型关节镜技术。对于关节盂骨丢失率（GBL%）为10% - 20%的骨性Bankart损伤的治疗仍是一个灰色地带，在此情况下，骨增强手术属于过度治疗，而关节盂唇修复则与高复发率相关。
对30例有前方不稳定病史且GBL%<20%的患者进行回顾性研究，将其分为两组。SB组包括接受关节镜下肩胛下肌增强治疗的患者，而CB组包括接受关节镜下关节盂唇修复治疗的患者。这些患者在术后至少24个月进行随访，并使用WOSI、ASES和ROWE评分评估功能结果。
SB组患者在WOSI和ROWE评分方面显示出更好的功能结果。考虑术后肩部疼痛，SB组的中位ROWE - P（疼痛）评分为10/10，优于CB组的5/10。SB组患者对肩部的身体症状更满意（WOSI - P平均为60/1000），并且更有可能继续进行娱乐性体育活动（SB组的WOSI - 运动评分为63.7，CB组为119.5）。在我们的研究中，15例SB患者中无一例肩部活动范围受限[ROWE - M评分为10]。肩胛下肌增强Bankart修复术与肩部活动范围受限最小、疼痛缓解更好、可接受性更好以及恢复日常生活和工作更顺利相关，对于GBL<20%的每位患者可将其视为常规治疗方法。
