Grana W A, Buckley P D, Yates C K
Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma College of Medicine, Oklahoma City.
Am J Sports Med. 1993 May-Jun;21(3):348-53. doi: 10.1177/036354659302100304.
The purpose of this paper was to report our experience with an arthroscopic technique of repair for the Bankart lesion following shoulder instability. Twenty-seven patients (average age, 21.7 years) were followed for an average of 36 months after arthroscopic suture stabilization of anterior shoulder instability. Patients were excluded if instability was multidirectional or voluntary and if there was radiographic evidence of a significant loss of glenoid bone stock. Clinical evaluation using a functional grading system showed that 10 patients were rated as excellent, 5 good, and 12 poor. Fourteen patients returned to their previous level of activity. There were 12 patients rated as failed; all had recurrent instability of the shoulder. Success was associated with a period of immobilization of 3 weeks or longer and a history of acute injury, especially subluxation. Failures were associated with shorter immobilization periods after surgery and in patients who had recurrent dislocations. The younger patient, who may not have complied with the immobilization protocol, also seemed to be associated with failure. Contact sports seems to leave a patient at high risk for recurrence. We recommend caution in the use of arthroscopic procedures for the competitive athlete in whom a second surgery and rehabilitation might mean loss of more sports participation.
本文旨在报告我们采用关节镜技术修复肩关节不稳后Bankart损伤的经验。27例患者（平均年龄21.7岁）在接受关节镜下前肩关节不稳缝合稳定术后平均随访36个月。如果存在多向性或主动性不稳，以及有影像学证据显示肩胛盂骨量明显丢失，则将患者排除。使用功能分级系统进行临床评估显示，10例患者评为优秀，5例良好，12例差。14例患者恢复到了之前的活动水平。有12例患者被评为失败；所有患者均出现了复发性肩关节不稳。成功与3周或更长时间的固定期以及急性损伤病史，尤其是半脱位病史相关。失败与术后较短的固定期以及有复发性脱位的患者相关。年轻患者可能未遵守固定方案，似乎也与失败相关。接触性运动似乎会使患者复发风险较高。对于竞技运动员，我们建议谨慎使用关节镜手术，因为二次手术和康复可能意味着更多运动参与机会的丧失。
