Shea K P
Department of Orthopaedics, University of Connecticut Health Center, Farmington, USA.
Clin Sports Med. 1996 Oct;15(4):737-51.
Recurrent instability in athletes may lead to decreased athletic performance and interference with activities of daily living. When a Bankart lesion is created, the probability that instability will recur is high. Open Bankart repairs have been shown to produce greater than 95% good to excellent results but do require extensive dissection and may result in significant loss of external rotation of the shoulder. This loss of external rotation may interfere or prevent the resumption of athletic activities. Arthroscopic Bankart repair offers the hope of re-creating shoulder stability surgically with minimal damage to the surrounding tissues, resulting in little, if any, loss of external rotation. Arthroscopic Bankart repair is demanding and is associated with an increased risk of failure compared with open techniques. If the surgeon remains cognizant of the precise technical details of arthroscopic Bankart repair, greater than 90% good to excellent results should be achieved with arthroscopic shoulder stabilization. In discussing arthroscopic versus open repair with an athlete, however, the surgeon should talk about his or her own results with the procedure to allow an athlete to make an informed decision. The author believes that arthroscopic Bankart repair is appropriate for all overhead athletes requiring as much external rotation of the shoulder as possible, noncontact athletes, athletes who have dislocated three or fewer times, and those who do not have a significant degree of generalized ligamentous laxity. It also may be appropriate for the low-demand patient who dislocates a shoulder in an accident (e.g., a fall) and, after stabilization, is not expected to place significant demands on the shoulder. The author also believes that arthroscopic Bankart repair is not appropriate in patients with generalized ligamentous laxity, in patients with more than three dislocations (unless they are an overhead athlete), in patients who are found to have poor quality tissue at the time of arthroscopy, or in athletes who are perceived to be noncompliant. Open procedures are probably more appropriate in each of these groups of patients.
运动员反复出现的关节不稳可能导致运动表现下降，并干扰日常生活活动。当形成Bankart损伤时，关节不稳复发的可能性很高。开放Bankart修复术已被证明能产生大于95%的良好至优秀结果，但确实需要广泛的解剖，并且可能导致肩部外旋明显丧失。这种外旋丧失可能会干扰或阻止恢复体育活动。关节镜下Bankart修复术有望通过对周围组织造成最小损伤来手术重建肩部稳定性，从而几乎不会（如果有的话）导致外旋丧失。关节镜下Bankart修复术要求较高，与开放技术相比失败风险增加。如果外科医生牢记关节镜下Bankart修复术的精确技术细节，关节镜下肩部稳定术应能取得大于90%的良好至优秀结果。然而，在与运动员讨论关节镜修复术与开放修复术时，外科医生应谈论自己进行该手术的结果，以便运动员做出明智的决定。作者认为，关节镜下Bankart修复术适用于所有需要尽可能多肩部外旋的过头运动运动员、非接触性运动员、脱位三次或更少的运动员，以及那些没有明显全身性韧带松弛的运动员。它也可能适用于在事故（如跌倒）中肩部脱位且稳定后预计对肩部需求不大的低需求患者。作者还认为，关节镜下Bankart修复术不适用于全身性韧带松弛的患者、脱位超过三次的患者（除非他们是过头运动运动员）、关节镜检查时发现组织质量差的患者，或被认为不依从的运动员。在这些患者群体中，开放手术可能更合适。
