Kartus J, Ejerhed L, Funck E, Köhler K, Sernert N, Karlsson J
Department of Orthopaedics, Norra Alvsborg Hospital, Trollhättan, Sweden.
Knee Surg Sports Traumatol Arthrosc. 1998;6(3):181-8. doi: 10.1007/s001670050096.
The aim of this study was to compare the clinical and radiographic results in patients with recurrent unidirectional, post-traumatic shoulder instability (dislocations/subluxations). All the patients had a Bankart lesion and underwent reconstruction using either an open or an arthroscopic technique and absorbable implants. Thirty-three consecutive patients (36 shoulders) were operated on by one surgeon. Group A comprised 18 shoulders which underwent an open Bankart reconstruction using absorbable 3.7-mm TAG suture anchors. Group B comprised 18 shoulders which underwent a combination of an intra- and extra-articular arthroscopic stabilization using 8-mm Suretac fixators. The median number of dislocations before the reconstruction was 5(0-45) in group A and 4 (0-30) in group B (NS). The follow-up examination was performed by an independent observer after a median of 31 (range 25-38) months in group A and 28 (range 18-46) months in group B (NS). An independent radiologist without any knowledge of the surgical procedure evaluated all the radiographs. There were no re-dislocations in either group. In group A, the Rowe and Constant scores were 86 (range 61-98) and 89 (range 73-99), respectively. The corresponding values in group B were 92 (range 83-98; P = 0.05) and 96 (range 75-100; NS). The external rotation in abduction was 65 degrees (range 20 degrees-90 degrees) in group A and 83 degrees (range 65 degrees-105 degrees) in group B (P = 0.0017). The radiographs revealed that 10/18 (56%) in group A and 4/18 (23%) in group B had visible drill-holes or cystic formations in conjunction with the drill-holes (P = 0.002). In this study the open procedure resulted in a restriction in external rotation more frequently than the arthroscopic procedure. The radiographs revealed visible drill-holes or cystic formations in conjunction with the drill-holes more frequently when TAG suture anchors were used than when Suretac fixators were used. The radiographic changes did, not appear to affect the clinical outcome, however.
本研究的目的是比较复发性单向创伤后肩关节不稳（脱位/半脱位）患者的临床和影像学结果。所有患者均有Bankart损伤，并采用开放或关节镜技术及可吸收植入物进行重建。由一名外科医生对33例连续患者（36个肩关节）进行手术。A组包括18个肩关节，采用可吸收的3.7毫米TAG缝线锚钉进行开放Bankart重建。B组包括18个肩关节，采用8毫米Suretac固定器进行关节内和关节外联合关节镜稳定术。重建前脱位的中位数在A组为5次（0 - 45次），在B组为4次（0 - 30次）（无显著性差异）。A组在中位随访31个月（范围25 - 38个月）后，B组在中位随访28个月（范围18 - 46个月）后，由一名独立观察者进行随访检查（无显著性差异）。由一名对手术过程不知情的独立放射科医生对所有X线片进行评估。两组均无再次脱位。在A组，Rowe评分和Constant评分分别为86分（范围61 - 98分）和89分（范围73 - 99分）。B组的相应值分别为92分（范围83 - 98分；P = 0.05）和96分（范围75 - 100分；无显著性差异）。A组外展时的外旋角度为65度（范围20度 - 90度），B组为83度（范围65度 - 105度）（P = 0.0017）。X线片显示，A组18例中有10例（56%），B组18例中有4例（23%）有可见的钻孔或与钻孔相关的囊性形成（P = 0.002）。在本研究中，开放手术比关节镜手术更频繁地导致外旋受限。与使用Suretac固定器相比，使用TAG缝线锚钉时，X线片更频繁地显示可见的钻孔或与钻孔相关的囊性形成。然而，影像学改变似乎并未影响临床结果。
