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使用两个锚钉(一个单负荷加一个双负荷)关节镜下稳定复发性前肩不稳:一项改良技术的前瞻性研究

Arthroscopic Stabilization of Recurrent Anterior Shoulder Instability Using Two Anchors, One Single-Loaded plus One Double-Loaded; a Prospective Study with Modified Technique.

作者信息

Kokly Saeed, Castagna Alessandro, Etemadi Ramin, Hosseininejad Seyyed-Mohsen

机构信息

Department of Orthopedic Surgery, 5th Azar hospital, Golestan University of Medical Sciences, Gorgan, Iran.

Joint, Bone, Connective tissue Rheumatology Research Center (JBCRC), Golestan University of Medical Sciences, Gorgan, Iran.

出版信息

Arch Bone Jt Surg. 2024;12(11):770-778. doi: 10.22038/ABJS.2024.72841.3379.

Abstract

OBJECTIVES

Anterior shoulder instability with minimal glenoid bone loss has several options for Bankart repair. We aimed to evaluate the results of a modified technique using two anchors with double and single loaded suture (three stitches in total) in arthroscopic Bankart surgery.

METHODS

Thirty-eight patients underwent arthroscopic Bankart surgery and were assessed after an average 40 months follow-up. They underwent two-anchor repairs with single loaded of a high-strength, non-absorbable braided suture and double loaded suture. The participants were assessed preoperatively and postoperatively in terms of range of motion, CONSTANT Scores, and visual analogue scale (VAS). Recurrence of subluxations, dislocations, and other complications were also assessed.

RESULTS

The mean follow-up time was 40.1±6.99 months. The mean Constant scores were 80.32±4.81 (95%CI: 78.73-81.90) preoperatively and 94.45±3.71 (95%CI: 93.23-95.67) postoperatively (P = < 0.001). A significant change was noted for the VAS score from 2.74±0.95 (95%CI: 2.42-3.05) to 0.63±0.75 (95%CI: 0.38-0.88) (P < 0.001). Mean preoperative external rotation and forward flexion were also preserved postoperatively (P < 0.001). The incidence of nonclinical subluxation was 2/38, 5.3%, however no case of clinical subluxation or re-dislocation was occurred; infection or neurovascular complications have not been observed as well.

CONCLUSION

Using two anchors with single and double loaded arthroscopic suture showed acceptable clinical results for traumatic anterior shoulder instability repair in properly selected patients.

摘要

目的

对于关节盂骨量丢失极少的前肩不稳,Bankart修复有多种选择。我们旨在评估在关节镜下Bankart手术中使用两个锚钉,分别采用单股和双股缝线加载(共三针)的改良技术的效果。

方法

38例患者接受了关节镜下Bankart手术,并在平均随访40个月后进行评估。他们接受了双锚钉修复,其中一个锚钉采用高强度、不可吸收编织缝线单股加载,另一个采用双股缝线加载。对参与者术前和术后的活动范围、Constant评分和视觉模拟量表(VAS)进行评估。还评估了半脱位、脱位及其他并发症的复发情况。

结果

平均随访时间为40.1±6.99个月。Constant评分术前平均为80.32±4.81(95%CI:78.73 - 81.90),术后为94.45±3.71(95%CI:93.23 - 95.67)(P = < 0.001)。VAS评分从2.74±0.95(95%CI:2.42 - 3.05)显著变化至0.63±0.75(95%CI:0.38 - 0.88)(P < 0.001)。术前平均外旋和前屈术后也得以保留(P < 0.001)。非临床性半脱位发生率为2/38,即5.3%,然而未发生临床半脱位或再脱位病例;也未观察到感染或神经血管并发症。

结论

对于适当选择的患者,在关节镜下使用单股和双股缝线加载的两个锚钉进行创伤性前肩不稳修复显示出可接受的临床效果。

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