目的:在接触性和头顶运动员中合并骨损伤并伴有亚临界性骨丢失的肱骨不稳对高复发性不稳定的治疗具有挑战性。治疗选择是关节镜下Bankart修复术,包括remplissage和Latarjet手术。然而,对它们的有效性没有共识。这项研究旨在比较两种手术后的临床结果和恢复运动,以及评估关节盂骨丢失和Hill-Sachs宽度以计算总骨丢失是否有助于确定合适的手术。
方法:在本回顾性比较分析中,纳入了30名在2017年至2020年期间接受了带remplissage(n=16)或Latarjet手术(n=14)的索引关节镜Bankart修复术的运动员.常规进行计算机断层扫描(CT)和磁共振成像(MRI)。手臂的快速残疾,肩和手(qDASH)美国肩肘外科医师(ASES),在术前和平均随访53个月时记录不稳定严重度指数(ISI)评分和活动范围(ROM).后续活动包括时间返回运动,自我感知的运动表现水平和并发症/复发性脱位。
结果:术前qDASH,ASES,ISI得分,年龄和性别相似。Latarjet组的关节盂骨丢失明显较大,Hill-Sachs宽度和总骨丢失(p<0.01)。两组在术后患者报告的结果(PROs)均有显著改善(p<0.01)。总骨丢失<25%的运动员接受了关节镜下Bankart修复术,并且总骨丢失≥25%的运动员接受了Latarjet手术,两组之间在术后PRO方面没有差异,ROM,时间回归运动和表现。没有再错位。
结论:关节镜下Bankart修复术与Romplissage或Latarjet手术可以充分解决合并骨病变的肱骨不稳。总骨丢失评分大于或等于25的患者可能特别受益于Latarjet手术,而微创关节镜下Bankart修复与remplissage可以产生同样令人满意的总骨丢失小于25分。
方法:三级。
OBJECTIVE: Glenohumeral instability with combined bone lesion in contact and overhead
athletes with subcritical bone loss is challenging to treat with high recurrent instability. Treatment options are arthroscopic Bankart repair with remplissage and Latarjet operations. However, there is no consensus on their effectiveness. This study aims to compare the clinical outcomes and return to sports after both operations and whether evaluating the glenoid bone loss and Hill-Sachs width to calculate the total bone loss can help determine the appropriate operation.
METHODS: In this retrospective comparative analysis, 30
athletes who underwent index arthroscopic Bankart repair with remplissage (n = 16) or Latarjet procedure (n = 14) between 2017 and 2020 were included. Computed tomography (CT) and magnetic resonance imaging (MRI) were routinely performed. The quick Disabilities of the Arm, Shoulder and Hand (qDASH), American Shoulder and Elbow Surgeons (ASES), instability severity index (ISI) scores and range of motion (ROM) were recorded preoperatively and at a mean follow-up of 53 months (SD = 12). Follow-up included time-to-return sports, self-perceived sports performance level and complications/recurrent dislocations.
RESULTS: Preoperative qDASH, ASES, ISI scores, ages and genders were similar. The Latarjet group had significantly larger glenoid bone loss, Hill-Sachs width and total bone loss (p < 0.01). Both groups had significant improvement in patient-reported outcomes (PROs) after the operations (p < 0.01).
Athletes with a total bone loss <25% underwent arthroscopic Bankart repair with remplissage and total bone loss ≥25% underwent Latarjet procedure, and there were no differences between the groups in terms of postoperative PROs, ROM, time-to-return sports and performance. There were no re-dislocations.
CONCLUSIONS: Arthroscopic Bankart repair with remplissage or Latarjet procedure can adequately address glenohumeral instability with combined bone lesions. Patients with total bone loss scores greater than or equal to 25 may particularly benefit from the Latarjet procedure, while the minimally invasive arthroscopic Bankart repair with remplissage can yield equally satisfying scores for total bone loss less than 25.
METHODS: Level III.