Rowe C R, Zarins B, Ciullo J V
J Bone Joint Surg Am. 1984 Feb;66(2):159-68.
We analyzed the cases of thirty-nine patients who were treated for recurrent anterior dislocation of the shoulder after unsuccessful surgical repair for the same condition in order to identify factors responsible for failure of the earlier operations and to determine the results of treatment of the post-surgical recurrence. The prior operations included nineteen Bankart, seven Putti-Platt, five Magnuson, three duToit, two Bristow, and three Nicola procedures. Thirty-two shoulders were treated by reoperation. At reoperation the most common pathological lesion associated with recurrence of the dislocation after the prior repair was a Bankart lesion (avulsion of the capsule and labrum from the anterior glenoid rim). This was present in 84 per cent of the thirty-two shoulders that were treated by reoperation. Excessive laxity of the capsule was found in 83 per cent of the twenty-nine shoulders in which laxity was assessed, and was considered to be the primary cause of instability in four shoulders. A Hill-Sachs lesion of the humeral head was found in 76 per cent of the twenty-nine shoulders that were evaluated for this lesion and was large in three of the shoulders. Other factors that were associated with recurrent instability were scarring of the subscapularis muscle, generalized ligament laxity, technical errors at surgery, and severe reinjury. The success rate of reoperation after previous failure was very encouraging. Of the twenty-four shoulders that were reoperated on and were followed for two years or longer, ten were graded excellent; twelve, good; and two, poor. One (4 per cent) of the twenty-four shoulders that were reoperated on continued to dislocate and another shoulder continued to subluxate, making the incidence of recurrent instability after reoperation 8 per cent. Seven of the thirty-nine shoulders did not have a reoperation but were treated with specific resistive exercises. The results in these were one excellent, four good, one fair, and one poor. Eight patients were lost to follow-up.
我们分析了39例患者的病例，这些患者因相同病情接受手术修复失败后出现复发性肩关节前脱位，目的是确定导致早期手术失败的因素，并确定手术复发后的治疗结果。先前的手术包括19例Bankart手术、7例Putti-Platt手术、5例Magnuson手术、3例duToit手术、2例Bristow手术和3例Nicola手术。32例肩部接受了再次手术。再次手术时，先前修复后与脱位复发相关的最常见病理病变是Bankart损伤（关节囊和盂唇从前盂缘撕脱）。在接受再次手术的32例肩部中，84%存在这种损伤。在评估的29例肩部中，83%发现关节囊过度松弛，4例肩部被认为是不稳定的主要原因。在评估有此病变的29例肩部中，76%发现肱骨头有Hill-Sachs损伤，其中3例肩部损伤较大。与复发性不稳定相关的其他因素包括肩胛下肌瘢痕形成、全身韧带松弛、手术技术失误和严重再损伤。先前失败后再次手术的成功率非常令人鼓舞。在接受再次手术并随访两年或更长时间的24例肩部中，10例评为优秀；12例为良好；2例为差。接受再次手术的24例肩部中有1例（4%）继续脱位，另1例肩部继续半脱位，再次手术后复发性不稳定的发生率为8%。39例肩部中有7例未接受再次手术，而是接受了特定的抗阻锻炼。这些患者的结果为1例优秀、4例良好、1例中等和1例差。8例患者失访。
