Chih-Hao Chiu Joe, Guevara-Alvarez Alberto, Lädermann Alexandre
Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Arthrosc Tech. 2024 Oct 5;14(3):103256. doi: 10.1016/j.eats.2024.103256. eCollection 2025 Mar.
Augmented Bankart with dynamic anterior stabilization (DAS) using the long head of the biceps tendon (LHBT) aims to address anteroinferior glenohumeral instability but does not specifically target Hill-Sachs lesions. The remplissage technique, "filling" the Hill-Sachs lesion, is popular for off-track lesions. The proposed combined approach seeks to stabilize the humeral head without sacrificing the coracoid, making it suitable for high-risk patients prone to recurrent shoulder instability, such as patients with subcritical glenoid bone loss. The operative technique includes patient preparation, creation of arthroscopic portals, confirmation of glenoid bone loss and other injuries, LHBT preparation and tenodesis to the anterior glenoid, and completion of the remplissage procedure. Postoperative protocols involve wearing a sling, self-mobilization, and gradual return to sports. The method aims to improve stability and outcomes in patients with complex shoulder instability issues. The DAS and remplissage is a rational choice for high-demand patients with subcritical glenoid bone loss and on-track Hill-Sachs lesions because it may provide better stability than isolated Bankart repair or Bankart plus remplissage procedures.
使用肱二头肌长头肌腱（LHBT）进行动态前路稳定（DAS）的增强型Bankart手术旨在解决肩盂肱关节前下不稳定问题，但并未专门针对Hill-Sachs损伤。“填充”Hill-Sachs损伤的 remplissage技术在处理偏离轨道的损伤时很常用。所提出的联合方法旨在稳定肱骨头，同时不牺牲喙突，使其适用于容易复发肩关节不稳定的高危患者，如存在临界以下肩盂骨丢失的患者。手术技术包括患者准备、创建关节镜入路、确认肩盂骨丢失及其他损伤、准备LHBT并将其固定至肩盂前方，以及完成remplissage手术步骤。术后方案包括佩戴吊带、自主活动以及逐渐恢复运动。该方法旨在改善存在复杂肩关节不稳定问题患者的稳定性和治疗效果。对于存在临界以下肩盂骨丢失和轨道内Hill-Sachs损伤的高要求患者，DAS和remplissage是一种合理的选择，因为它可能比单纯的Bankart修复或Bankart加remplissage手术提供更好的稳定性。
