Nérisson D, Kempf J F, Bonnomet F, Gastaud F
Service d'Orthopédie, Hôpital de Hautepierre, Strasbourg.
Rev Chir Orthop Reparatrice Appar Mot. 1996;82(4):275-87.
The authors studied the results of the arthroscopic staple capsulorrhaphy of 55 patients who had recurrent anterior shoulder instability.
There were 38 men and 17 women. The average age at operation was 30.3 years (17 to 68) and the dominant side was injured in 33 patients. 28 (51 per cent) patients had recurrent dislocations, 19 (38 per cent) patients had recurrent subluxations and 8 (14 per cent) complained of a painful shoulder with instability. Multidirectionnal hyperlaxity and glenoid rim fracture cases were excluded from this study. The average duration of symptoms was 43 months (i to 180). At operation, 46 patients had a Bankart lesion (Adolfsson A or C) and 9 had "non Bankart" lesion (Adolfsson B and intra ligamentous disruption). There were 6 (11 per cent) SLAP II lesions and 23 (42 per cent) other glenoid labral tears associated with main instability lesions. 58 staples were inserted. 53 inferior glenoid humeral ligament were fixed to the glenoid rim and in 2 cases we performed a subscapularis tendon tenodesis.
The follow-up was continued for at least 18 months after treatment by an examiner different from the operating surgeon. (Average follow-up was 29.8 months). The results were assessed according to "Duplay" rating scale. Overall we have obtained 64 per cent excellent and good results. 71 per cent of shoulders were considered stable at revision whereas 7 per cent showed recurrent dislocation. 60 per cent of patients were able to return to their previous sport level. A limited range of motion was noted in only 11 per cent of cases. On the other hand 54 per cent of patients presented persistent pain. With regard to the shoulder stability, the factors possibly having a negative influence were the occurrence of an initial acute dislocation, the destruction of the inferior glenohumeral ligament (disruption or absence) and the sub-equatorial position of the staple on the anterior glenoid rim. Pain was more frequent in cases where there was associated subacromial impingement and where the staples had been badly positioned.
We have compared our results with those of other authors who also performed stapling procedures, including different arthroscopic techniques and results of open stabilization surgery. Our results regarding shoulder instability were better than those obtained by arthroscopic sutures, equivalent to those obtained by the "Open Bankart" procedure, but less impressing than those obtained by the "Bone Block" procedure (Patte). However, pain was observed much more frequently than with all the other stabilization techniques, arthroscopic or not.
Arthroscopic stapling therefore seemed to be less reliable than the "Patte Bone Block" procedure. At present, we reserve arthroscopic stabilization for patients with a good inferior glenohumeral ligament. Until an adapted biodegradable staple is perfected, we still use an anchorsuture technique to avoid pain due to metallic implant.
作者研究了55例复发性肩关节前脱位患者的关节镜下钉合关节囊缝合术的结果。
男性38例，女性17例。手术平均年龄为30.3岁（17至68岁），33例患者患侧为优势侧。28例（51%）患者有复发性脱位，19例（38%）患者有复发性半脱位，8例（14%）患者主诉肩部疼痛伴不稳定。本研究排除多向性关节松弛和肩胛盂边缘骨折病例。症状平均持续时间为43个月（1至180个月）。手术时，46例患者有Bankart损伤（Adolfsson A或C型），9例有“非Bankart”损伤（Adolfsson B型和韧带内断裂）。有6例（11%）SLAP II型损伤，23例（42%）其他肩胛盂唇撕裂与主要不稳定损伤相关。共插入58枚钉。53例将下盂肱韧带固定于肩胛盂边缘，2例进行了肩胛下肌腱固定术。
由与手术医生不同的检查者在治疗后至少随访18个月（平均随访29.8个月）。根据“Duplay”评分量表评估结果。总体而言，我们获得了64%的优良结果。翻修时71%的肩部被认为稳定，而7%的肩部出现复发性脱位。60%的患者能够恢复到之前的运动水平。仅11%的病例出现活动范围受限。另一方面，54%的患者存在持续性疼痛。关于肩关节稳定性，可能产生负面影响的因素包括初始急性脱位的发生、下盂肱韧带的破坏（断裂或缺失）以及钉在前肩胛盂边缘的赤道下位置。在伴有肩峰下撞击和钉位置不佳的情况下，疼痛更为常见。
我们将我们的结果与其他进行钉合手术的作者的结果进行了比较，包括不同的关节镜技术和开放稳定手术的结果。我们关于肩关节不稳定的结果优于关节镜缝合术的结果，与“开放Bankart”手术的结果相当，但不如“骨块”手术（Patte）的结果令人印象深刻。然而，与所有其他稳定技术（无论是否为关节镜技术）相比，疼痛出现的频率要高得多。
因此，关节镜下钉合术似乎不如“Patte骨块”手术可靠。目前，我们仅对下盂肱韧带良好的患者采用关节镜稳定术。在改良的可生物降解钉完善之前，我们仍使用锚钉缝合技术以避免金属植入物引起的疼痛。
