肩关节镜下行Bankart术治疗复发性肩关节前脱位

目的 探讨肩关节镜下Bankart术治疗复发性肩关节前脱位的适应症、手术要点和疗效。方法 对我科2007年1月至2009年7月,15例复发性肩关节前脱位的临床资料进行回顾性分析。15例均为肩关节单方向不稳定,左侧4例,右侧11例,术前脱位次数为2-30次,平均为11.7次。所有患者均采用锚钉进行关节镜下Bankart术,术后采用Constant-Murley法进行评分。结果 术后随访10-24个月,平均12.5个月,所有患者均未出现切口感染及关节腔积血等并发症。终末随访时平均Constant-Murley评分较术前明显改善（术前79.3±4.0对术后95.0±2.2,p<0.01）。终末随访时所有病例均未发生再脱位,术后无残存恐惧试验阳性。结论 关节镜下Bankart术是治疗复发性肩关节前脱位的有效方法之一。     

关节镜下手术治疗肩关节习惯性前脱位

<正>2008年6月~2011年12月,我科在关节镜下手术治疗21例肩关节习惯性前脱位患者,效果满意,现报道如下。1材料与方法1.1病例资料本组21例,男14例,女7例,年龄16~63岁。左肩7例,右肩14例。损伤原因:投掷伤12肩,暴力摔伤6肩,高处坠落伤3肩。初次脱位后均行过手法复位,其中11例患肢首次脱位后未行固定,10例患肢行绷带悬吊固定1~3周,继而习惯性脱位发生,脱     

关节镜下非打结型与打结型缝合锚钉Bankart重建治疗复发性肩关节前向不稳

目的探讨关节镜下非打结型与打结型缝合锚钉对复发性肩关节前向不稳Bankart损伤的临床效果。方法回顾性分析2006年3月至2009年1月广州军区广州总医院收治的44例复发性肩关节脱位Bankart损伤患者的临床资料,根据关节镜下修复方式的不同分为非打结组（可吸收非打结型缝合锚钉修复,20例）和打结组（打结型缝合锚钉修复,24例）。采用美国肩肘外科医师（ASES）评分及Constant-Murley功能评分对患者术前、末次随访时肩关节功能进行评估,记录肩关节活动范围,观察并发症发生情况。结果所有患者获得随访,随访时间20～46个月,平均随访时间30个月。非打结组术前和终末随访时肩关节前屈上举角度、外展90°时外旋角度分别为（163±9）°和（170±4）°、（58±14）°和（90±6）°,术后外展90°时患侧外旋角度较健侧受限（8±6）°;术前和终末随访时ASES评分、Constant-Murley评分分别为（77.4±3.7）分和（94.3±2.6）分、（78.1±4.6）分和（93.9±3.7）分,两者比较,差异有统计学意义（P〈0.05）。打结组术前和终末随访时肩关节前屈上举角度、外展90°时外旋角度分别为（162±8）°和（170±6）°、（61±13）°和（91±6）°,术后外展90°时患侧外旋角度较健侧受限（5±3）°;术前和终末随访时ASES评分、Constant-Murley评分分别为（75.8±2.9）分和（95.1±3.7）分、（76.2±5.9）分和（92.8±5.2）分,两者比较,差异有统计学意义（P〈0.05）。两组间术前、术后各项指标比较,差异无统计学意义（P〉0.05）。患者均未出现术后再脱位,均重返伤前工作岗位。结论肩关节镜下Bankart重建手术是治疗复发性肩关节前向不稳的有效方法,非打结型和打结型缝合锚钉修复Bankart损伤疗效相似。     

肩关节镜下单排锚钉技术治疗急性骨性Bankart损伤的临床疗效

目的 探讨肩关节镜下单排锚钉技术治疗急性骨性Bankart损伤的临床疗效。方法 回顾性分析我院2015年3月至2016年9月收治的12例急性骨性Bankart损伤病人的临床资料。所有病人均为初次肩关节前脱位造成的急性骨性Bankart损伤。其中男9例,女3例,平均年龄为38.8岁。Bigliani分型：Ⅰ型8例,Ⅱ型4例。均采用肩关节镜下单排锚钉缝合修复,锚钉数量为3~4颗。通过影像学资料评估骨折愈合情况;临床检查肩关节恐惧试验评估肩关节稳定性;比较病人术前术后的改良版肩功能Rowe评分和疼痛视觉模拟量表（visual analogue scale, VAS）评分。收集病人末次随访时对手术结果的整体满意情况。结果 12例病人平均随访时间为15.3个月。所有病人骨折愈合良好,无复发脱位出现,肩关节恐惧试验转为阴性,无半脱位出现。关节活动度较术前明显改善。术后Rowe评分和VAS评分分别为（96.170±3.215）分、（0.580±0.793）分,较术前的（54.670±12.702）分、（3.670±1.371）分显著改善,差异均有统计学意义（P均＜0.05）。末次随访时,12例病人中,9例（75.0%）表示非常满意,2例（16.7%）满意,1例（8.3%）部分满意。结论 肩关节镜下单排锚钉缝合治疗初次肩关节前脱位造成的急性骨性Bankart损伤可以取得优异的临床疗效。     

Correlation between Bankart and Hill-Sachs lesions in anterior shoulder dislocation

Background: Bankart lesions and Hill‐Sachs lesions are commonly associated with anterior shoulder dislocations. The presence of Bankart lesion indicates the need for surgical repair. Magnetic resonance imaging (MRI) has been shown to be sensitive in detecting these two lesions. The aim of this study is to investigate the correlation between Bankart lesions and Hill‐Sachs lesions on MRI for patients with traumatic anterior shoulder dislocations. Methods: Between 2003 and 2005, 61 patients from Alfred and Sandringham Hospitals had an MRI as part of the investigation for traumatic anterior shoulder dislocations. The MRI scans were reviewed and subsequently confirmed by a radiologist to show the presence or absence of Bankart and Hill‐Sachs lesions. The data were then analysed by a statistician. Results: Although patients with one of these lesions were more than two‐and‐a‐half times as likely to have the other, small study numbers precluded this result from achieving statistical significance. (odds ratio, 2.67 (0.83–8.61), P = 0.10). Younger age was a strong predictor of a recurrence of shoulder dislocation (odds ratio, 0.93 (0.89–0.98), P = 0.005). The presence of Bankart or Hill‐Sachs lesions on MRI for the primary shoulder dislocation group was similar to the recurrent group (73% vs. 72% for Bankart lesion and 67% vs. 70% for Hill‐Sachs lesion). Conclusion: There is a strong correlation between both lesions. This apparent trend can be useful in predicting the presence of a Bankart lesion when a Hill‐Sachs lesion is identified on a plain radiograph. This study suggests the consideration of surgical repair after identification of a Hill‐Sachs lesion on plain radiographs, especially for younger patients where the rate of re‐dislocation is high.     

关节镜下非打结型缝合锚钉修补Bankart损伤治疗复发陛肩关节前脱位

目的 探讨关节镜下非打结型缝合锚钉修补Bankan损伤治疗复发性肩关节前脱位的疗效.方法 复发性肩关节前脱位患者14例,均为男性;年龄18～34岁,平均25.2岁;左侧4例,右侧10例,涉及主力侧12例;均为单向不稳.术前脱位次数为3～36次,平均13.5次.关节镜下采用可吸收非打结型缝合锚钉治疗Bankart损伤.术前及术后随访采用ASES评分及Constant-Murley功能评估.结果 所有患者均获得随访,随访时间11～22个月,平均17个月.术中发现9例合并Hill-Sachs损伤,3例合并骨性Bankart损伤,2例合并后下盂唇损伤,2例合并SLAPⅡ型损伤,1例合并关节内游离体.14例患者术前及末次随访时肩关节平均前屈上举为163.4°±8.6°和169.7°±4.2°;外展90°时,平均外旋角度分别为58.5°+13.6°和90.3 °±5.5.;术后外展90°时,患侧外旋角度较健侧受限8.4°±6.2°术前及末次随访时ASES评分为(77.4±3.7)分和(94.3±2.6)分,两者比较差异有统计学意义(P＜0.05);其中VAS不稳定评分平均为(7.2±1.4)分和(1.2 ±0.6)分(P＜0.01);Constant-Mudey评分平均为(78.1±4.6)分和(93.9±3.7)分.术后无一例患者发生再脱位,且均重返伤前工作岗位.结论 肩关节镜下Bankart 重建手术是治疗复发性肩关节脱位的有效方法 .非打结型缝合锚钉简化了手术操作步骤,减少手术时间和创伤.     

Bankart operation for recurrent anterior dislocation of the shoulder using suture anchor

Between June 1989 and December 1994, a total of 19 patients (20 shoulders) underwent open repair of Bankart lesions using suture anchors. Subscapularis muscle and anterior capsule were cut as one layer and sutured end to end without overlap. Coracoid osteotomy was not necessary. Average follow-up was 53.6 months (range: 24-90 months). Clinical evaluation using the Rowe functional grading system showed 15 shoulders had excellent results, 3 shoulders had good results, and 1 patient was lost to follow-up. There were no complications and no failures with recurrence of dislocation.     

Surgical delay for traumatic recurrent shoulder dislocations leads to inferior functional outcomes

BackgroundThe effect of time interval between injury and surgery on outcomes of Bankart repair surgery has not been published previously. The purpose of this study was to assess the effect of surgical delay on functional outcomes after arthroscopic Bankart repair.MethodOne hundred and five athletes who underwent arthroscopic Bankart repair ± remplissage were enrolled in the study. Patients were divided into 2 groups depending upon the injury to surgery time- < 12 months (n = 19), and ≥12 months (n = 86). Depending upon the number of episodes of dislocation, patients were further categorized into 2 groups- <10 episodes (n = 66) and ≥10 episodes (n = 39). All patients were assessed post-operatively for functional outcomes (Modified Rowe's score, Constant Murley score) and return to sports at a minimum of 2 years of follow-up.ResultsThe mean injury to surgery time was 31.7 ± 23.1 months. The average number of episodes of dislocation before surgery were 10 (range 3–50). 49/105 (46.7%) patients returned to sports after a mean post-operative duration of 10.9 months. Athletes operated after a surgical delay of ≥12 months had inferior functional outcomes (Modified Rowe's score-89.5 ± 8.9 vs.77.4 ± 21.4; p = 0.02), lower rate of return to sports (14/19 vs. 35/86; p = 0.02) and higher mean time to return to sports (8.7 ± 1.9 vs. 11.5 ± 2.6; p < 0.05). Similarly, athletes who had ≥10 dislocations before surgery had inferior functional outcomes (Modified Rowe's score-84.5 ± 15.2 vs.72.9 ± 25.6; p = 0.004), lower rate of return to sports (37/66 vs. 12/39; p = 0.02) and higher mean time to return to sports (10.3 ± 2.4 vs. 12.6 ± 2.5; p < 0.05).ConclusionA delay in surgery (≥12 months) or dislocation episodes of ≥10 are associated with inferior functional outcomes, lower rate of return to sports and higher surgical failure rate.Level of evidenceLevel III; Prospective cohort study.     

复发性肩关节前脱位的关节镜治疗

目的探讨肩关节镜下Bankart重建手术治疗复发性肩关节前脱位的适应证、手术要点和疗效。方法随访28例应用肩关节镜下Bankart重建进行治疗的复发性肩关节前脱位患者,随访10～36个月,平均16.6个月;年龄15～50岁,平均27岁。28例均为单方向性不稳定,术前平均脱位次数为15.5次(2～60次),其中22例发生于主力侧。手术中采用金属缝合锚(Mini-Revo)进行Bankart重建。随访时采用ASES评分和Constant-Murley评分进行功能评估。结果28例患者手术前及终末随访时平均ASES评分为80.5±4.1对95.1±2.1(P<0.001),其中VAS不稳定评分平均为6.8±1.2对1.1±0.7(P<0.001),肩关节平均前屈上举为161.8°±9.0°对171.4°±5.9°(P<0.001),平均外展90°外旋为59.6°±14.3°对87.1°±7.2°(P<0.001);术前及终末随访时平均Constant-Murley评分为79.3±4.0对95.0±2.2(P<0.001)。终末随访时所有病例均未发生术后再脱位,术后残存恐惧试验阳性4例(14.3%),术后外展90°外旋较健侧平均受限7.9°±5.7°(0°～20°)。所有患者均恢复术前工作,20例(71.4%)恢复到第一次脱位前的运动水平。所有患者均表示如果健侧肩关节出现相同脱位情况时仍愿意接受相同的手术治疗。结论肩关节镜下Bankart重建手术是治疗复发性肩关节前脱位的有效方法之一     

复发性肩关节前脱位的关节镜治疗

目的 探讨肩关节镜下Bankart重建手术治疗复发性肩关节前脱位的疗效、适应证和手术要点.方法 随访40例应用肩关节镜下Bankart重建进行治疗的复发性肩关节前脱位患者,随访时间为24～58个月,平均35.9个月;年龄15～54岁,平均27.8岁.40例均为单方向性不稳定.术前平均脱位次数为14.1次(2～90次),其中28例发生于主力侧.术中采用金属缝合锚(Mini-Revo)进行Bankart重建.随访内容包括ASKS评分、Constant-Murley评分、VAS不稳定评分及ROWE评分进行功能评估.结果 40例患者术前和终末随访时肩关节前屈上举平均为[(157.5±20.6)°,x ±s.下同]和(170.0±6.7)°,体侧外旋平均为(58.5±18.9)°和(55.9±15.0)°,ASES评分平均为(82.7±16.7)和(97.2±6.9),VAS不稳定评分平均为(6.2±1.6)和(1.3±1.4),Constant-Murley评分平均为(80.5 ±11.1)和(98.1±3.1),Rowe评分平均为(30.4±8.7)和(92.8±15.2).除体侧外旋术前和术后差异无统计学意义外,其余各项结果差异均有统计学意义.终末随访时有1例患者曾出现肩关节半脱位.随访时发现残存恐惧试验阳性3例(占7.5%).所有患者均恢复术前工作,29例(占70.7%)恢复到第一次脱位前的运动水平.结论 肩关节镜下Bankart重建手术是治疗复发性肩关节前脱位的有效方法之一.适当的病例选择、术者的关节镜下操作技术水平及术后长期而严格的功能康复锻炼是手术成功的关键.     

关节镜下缝线桥技术治疗老年肩关节脱位合并冈上肌止点撕脱骨折

目的 探讨关节镜下缝线桥技术治疗老年肩关节脱位合并冈上肌止点撕脱骨折的临床疗效。方法 回顾性分析21例肩关节脱位合并冈上肌止点撕脱骨折老年病人的病例资料,其中男13例,女8例,年龄为（53.7±2.3）岁,受伤至手术时间为（2.8±1.3） d,均采用关节镜下缝线桥技术固定治疗冈上肌止点撕脱骨折。采用改良Constant-Murley评分、上肢功能障碍评分量表（Disability of Arm, Shoulder and Hand, DASH）评分、Rowe评分评价肩关节功能;采用测角仪评估病人术后的运动范围（前倾、外展、外旋）。术后复查X线评估骨折愈合情况。结果 本组21例随访（23.4±7.1）个月,未见骨折不愈合及肩袖再撕裂病人,2例（9.5%）由于肩关节僵硬进行了松解,1例有一次创伤性再脱位（4.8%）。患侧Constant-Murley评分为84.3%±11.2%,DASH评分为（12.7±7.3）分,Rowe评分为（81.8±9.2）分,与健侧相比,评分差异均无统计学意义（P均＞0.05）。运动范围方面,患侧和健侧在前屈、外展和内旋时的角度比较,差异均无统计学意义（P均＞0.05）,但两者主动外旋时的角度比较,差异有统计学意义（t=-8.904,P=0.018）。结论 关节镜下缝线桥技术治疗老年肩关节脱位合并冈上肌止点撕脱骨折可获得良好的功能效果,复发脱位率低。     

肩关节镜下锚钉固定位置与跨度对治疗复发性肩关节前脱位预后的影响

目的 评估肩关节镜下锚钉内固定术治疗复发性肩关节前脱位的临床疗效,并探讨锚钉固定位置、跨度对临床疗效的影响。方法 2013年1月至2016年6月,前瞻性纳入47例复发性肩关节前脱位病人,关节镜下使用3枚Lupine锚钉固定撕裂的盂唇。术后第2日常规复查肩关节三维CT,以表盘上的时间刻度描述锚钉位点及跨度。采用数字分级法（numerical rating scale, NRS）评估病人的疼痛程度;使用美国肩肘外科医师学会（American Shoulder and Elbow Surgeons, ASES）评分及Constant-Murley评分评估手术前后关节功能。使用丹麦健康与医疗管理局（Danish Health and Medicine Authority）满意度评分表评估病人满意度。分析锚钉固定位置、跨度等因素与Constant-Murley评分的关系。结果 47例病人术后未出现明显并发症,术后的NRS评分、ASES评分、Constant-Murley评分均较术前显著改善,差异均有统计学意义（P均＜0.05）。病人满意度评分为（8.2±1.3）分。锚钉跨度越大,Constant-Murley评分越低（F=21.714,P＜0.001）;锚定位置越高（越接近12点钟位置）,Constant-Murley评分越低（F=13.752,P=0.006）。结论 锚钉固定前下盂唇可有效改善病人肩关节功能,有利于肩关节稳定性重建,且锚钉固定的位置及跨度与肩关节术后稳定性相关。     

关节镜下Bankart修复术治疗肩关节复发性前脱位:手术效果及复发危险因素分析

目的 探讨关节镜下Bankart修复术(缝合锚钉技术)治疗肩关节复发性前脱位的临床效果,并对术后复发不稳的可能危险因素进行分析.方法 2002年3月至2010年3月连续收治肩关节复发性前脱位患者259例,均采用关节镜下缝合锚钉技术进行Bankart修复手术,其中188例患者获得随访.患者手术时平均年龄25.3岁(13～58岁);其中男性143例、女性45例;运动员50名、非运动员138名.随访时采用美国肩肘关节外科协会评分系统(ASES)肩关节评分、Rowe评分以及患者满意度评价手术效果.术前肩关节ASES评分平均72.6分,Rowe评分平均33.4分.对于肩关节术后不稳的复发率、关节活动范围以及术后复发不稳的危险因素进行评估.结果 188例患者术后平均随访38.6个月(12～110个月).术后肩关节ASES评分平均91.9分,与术前比较差异具有统计学意义(P＜0.001);术后Rowe评分平均81.9分,与术前比较差异具有统计学意义(P＜0.001).患者手术满意度调查显示,满意152例、基本满意16例、不满意20例,满意率为89.4%.术后有24例患者复发脱位,总体复发率为12.8%;运动员患者复发率为28.0%,非运动员复发率为7.2%.术后患者平均肩关节外展外旋为75.2°,与术前比较无明显丧失(P＞0.05).关节镜Bankart修复术后复发不稳与患者年龄及是否为运动员明显相关(P＜0.05);而与术前病程长短、锚钉类型、锚钉数目、骨性Bankart损伤、合并肩关节上盂唇撕裂损伤、合并后或下方盂唇损伤、合并肩袖撕裂、关节松弛以及肩袖间隙闭合等因素无明显相关(P＞0.05).结论 关节镜下采用缝合锚钉进行Bankart修复术是治疗肩关节复发性前脱位的有效方法,临床效果比较满意.年轻患者(≤20岁)和运动员患者是术后肩关节复发不稳的高危因素,必要时选择切开手术.

Abstract：

Objective To evaluate retrospectively the results of arthroscopic Bankart repair using suture anchors for recurrent anterior shoulder dislocation with a minimum 1-year follow-up and to assess risk factors for recurrence.Methods From March 2002 to March 2010,259 patients with recurrent anterior shoulder dislocation underwent arthroscopic Bankart repair with suture anchors.And 188 patients(50 athletes,138 nonathletes)were available for follow-up.The mean age at the time of surgery was 25.3 years (range,13-58 years).The mean follow-up was 38.6 months(range,12-110 months).All of the 188 patients were evaluated preoperatively and postoperatively with the American Shoulder and Elbow Society (ASES)shoulder score and Rowe score system.The rate of recurrent instability,range of motion,and risk factors for postoperative recurrence were evaluated.The ASES score was 72.6 preoperatively,and Rowe score was 33.4.Results The ASES scores improved significantly to 91.9 postoperatively(P＜0.001).The Rowe scores improved to 81.9 postoperatively(P＜0.001).And 152 patients were greatly satisfied with the results,16 satisfied and 20 unsatisfied.The satisfactory rate was 89.4%.24 patients(12.8%)suffered a recurrence after surgery,14 athletes and 10 nonathletes.The recurrence rates were 28.0% in the athlete group and 7.2% in the nonathlete group.On average there was no significant loss of external rotation postoperatively(average,75.2° preoperatively and 67.2° postoperatively).Patients under age 20,and athlete patients were associated with recurrence(P＜ 0.05).Other factors including length of time until surgery,type of anchors,number of anchors,presence of bony Bankart lesion,presence of a superior labrum,anterior and posterior tear,presence of posterior or inferior labrum lesion,presence of rotator cuff tear,ligamentous laxity and rotator interval closure did not influence the recurrence rate(P＞0.05).Conclusions Arthroscopic Bankart repair is a good option for the treatment of recurrent anterior shoulder dislocation.Identification of risk factors for recurrence allows for consideration of open stabilization.In the series,patients under age 20 and athlete patients are the most important risk factors for recurrence.     

Twelve years' experience of the mini-Bankart repair for recurrent anterior dislocation of the shoulder

Stabilization for recurrent anterior shoulder dislocation can be achieved through either an open or arthroscopic approach. The former tends to have a lower recurrence rate but longer rehabilitation.The technique of mini-Bankart repair has been used at this establishment since 1996. We retrospectively reviewed the patients that had undergone this procedure. We describe our experience of the mini-Bankart procedure and the results in 24 patients with a mean follow-up of 56 months (range, 12-144 months).The technique is a direct mini-approach to the shoulder joint, preserving the inferior portion of subscapularis. Where present, a Bankart lesion is repaired with two GII Mitek anchors (Ethicon) and the capsule reefed. There were no incidences of repeat anterior dislocation, and the average time period taken to return to work was 8.8 weeks. We recommend this technique due to its low recurrence rate and satisfactory return to normal function.     

Clinical results and motion analysis following arthroscopic anterior stabilization of the shoulder using bioknotless anchors

Purpose:

Traumatic anterior dislocation of the shoulder is a common occurrence increasingly being treated arthroscopically. This study aims to determine the outcome of arthroscopic anterior stabilization using bioknotless anchors and analyze the motion in a subset of these patients.

Materials and Methods:

The outcome of 20 patients who underwent arthroscopic anterior stabilization using the bioknotless system was studied (average follow-up 26 months). Four of these patients underwent motion analysis of their shoulder pre- and post-operatively.

Results:

15% were dissatisfied following surgery and the recurrence of instability was also 15%. Those who were dissatisfied or suffered recurrent symptoms had statistically significant lower constant scores at the final follow up. Pre-operative motion analysis showed a disordered rhythm of shoulder rotation which was corrected following surgery with minimal loss of range of motion.

Conclusions:

Our success rate was comparable to similar arthroscopic techniques and results published in the literature. Patient satisfaction depended more on return to usual activities than recurrence of symptoms. There was very little reduction in range of movement following surgery and the rhythm of shoulder motion, particularly external rotation in abduction was improved.

Level of Evidence:

Four retrospective series.     

Bilateral irreducible inferior shoulder dislocation: A case report

IntroductionBilateral inferior shoulder dislocation is rare; but the dislocation is almost always reducible by closed means. We present a unique case of irreducible bilateral inferior shoulder dislocation.Presentation of caseA 35-year old male fell down from height. Direct axial loading while both shoulders were fully abducted resulted in bilateral inferior shoulder dislocation. All attempts of closed reduction failed. Open reduction revealed that the cause of irreducibility was the entrapment of the humeral head in a button-hole through the inferior joint capsule and the surrounding soft tissue envelope. At 6 months, there was almost full range of motion and no pain.DiscussionThe direct axial loading resulted in a narrow defect in the inferior joint capsule/soft tissue envelope; and this may have led to button-hole entrapment of the dislocated humeral head and irreducibility. Open reduction required widening of the button-hole while protecting the axillary neurovascular bundle.ConclusionWe present a rare case of bilateral irreducible inferior shoulder dislocation. We highlight the pathomechanics of irreducibility: button-hole entrapment of the humeral head. We emphasize technical tips during open reduction such as widening of the button-hole and protection of the axillary neurovascular bundle. The outcome is good although some limitation of shoulder abduction is to be expected.