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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Outcomes after Arthroscopic Bankart Repair
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Outcomes after Arthroscopic Bankart Repair

机译：关节镜Bankart修复后的结果

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Objectives: The shoulder is the most common joint dislocation effecting roughly 2% of the general population. Males are effected to a higher degree that females at a ratio of 3:1.1-2 The young, athletic population make up the largest portion of shoulder instability, and treated nonoperatively have a recurrent dislocation rate approaching 50%.3-5 Owens et. al recently published a cohort looking at 45 college athletes with an in season shoulder instability event. 73% of athletes returned to play in season. Only 36% of athletes completed the season without re-injury and 64% of athletes had a recurrent instability event.6 It is unknown how the outcomes of those who go on to have a recurrent dislocation in season are effected versus those who have a stabilization procedure after a first time dislocation. The objective of the current study is to report the postoperative outcomes of first time dislocators versus patients with recurrent dislocations prior to surgery. Methods: CPT codes were used to identify patients who had arthroscopic Bankart repair between 2003-2013. 439 patients aged 16-30 years were identified across 8 fellowship trained surgical practices. The first phase of the study was a retrospective chart review to obtain patient demographics, number of reported preoperative dislocations, review imaging, and number of anchors placed. Patients were identified as first time dislocators or as recurrent dislocators when they had more than one dislocation prior to surgical intervention. The second phase consisted of a survey to obtain a simple shoulder test score, whether they returned to sport, postoperative instability events and further surgery on the shoulder. Postoperative instability was defined as a subluxation or dislocation reported by the patient survey in the postoperative period. Of the 439 patients identified, 296 were excluded for revision surgery, open repair, posterior instability, multidirectional instability, HAGL lesion, labral tears involving the biceps anchor and refusal to participate. This left 144 patients eligible for the study. Results: 121 patients participated for a follow up rate of 85% at an average of 51 months post surgery. There were 53 patients in the recurrent dislocation group and 68 in the first time dislocation group. The average age in both groups was 19yrs. The postoperative instability rate in the first time dislocator group was 9%. The postoperative instability rate in the recurrent dislocator group was 47%. This was statistically significant with p<0.0001. The first time dislocator group reported a 7% rate of repeat operation to address instability. The recurrent dislocator group reported a 32% rate of repeat operation to address instability. This was statistically significant with a p=0.0007. The Simple Shoulder Test (SST) score in the first time dislocator group was 11.4. The SST score in the recurrent dislocator group was 11. The difference was significant with p=0.037. Conclusion: First time dislocators had lower postoperative instability rates and reoperation rates when compared to patients with recurrent dislocations prior to surgical intervention. The SST scores were significantly different between groups. Young, athletic patients with shoulder instability should be offered early surgical intervention to lower the risk of postoperative instability and reoperation.
机译：目的：肩关节是最常见的关节脱位，约占总人口的2％。男性受到的影响比女性更高，比率为3：1.1-2。年轻的运动人群占肩部不稳定性的最大部分，未经手术治疗的复发性脱位率接近50％。3-5Owens等。最近，Al等人发表了一项队列研究，研究了45名发生季节性肩部不稳定事件的大学生。 73％的运动员回到了赛季。只有36％的运动员在整个赛季中没有再次受伤，而64％的运动员经历了反复失稳事件。6尚不清楚与稳定的人相比，本赛季反复失常者的结局如何受到影响第一次脱臼后的手术。本研究的目的是报告初次脱位患者与术前复发脱位患者的术后结果。方法：使用CPT代码识别在2003年至2013年之间接受关节镜行Bankart修复的患者。在8个研究金培训的外科实践中，确定了439名16-30岁的患者。研究的第一阶段是回顾性图表审查，以获取患者的人口统计学资料，术前脱位的数量，影像学检查以及放置的锚点的数量。如果患者在手术干预之前有多个脱位，则被确定为初次脱位或复发性脱位。第二阶段包括一项调查，以获取简单的肩膀测试成绩，是否恢复运动，术后不稳定事件以及进一步的肩膀手术。术后不稳定性定义为术后期间患者调查报告的半脱位或脱位。在确定的439例患者中，有296例被排除在翻修手术，开放性修复，后路不稳定，多向不稳定，HAGL病变，涉及二头肌锚固的唇泪和拒绝参与治疗之外。这使144名患者符合研究条件。结果：121例患者平均随访51个月，随访率达85％。复发性脱位组53例，首次脱位组68例。两组的平均年龄均为19岁。首次脱臼组的术后不稳定率为9％。复发性脱位组的术后不稳定率为47％。这在p <0.0001上具有统计学意义。首次脱臼组报告了7％的重复手术率，以解决不稳定问题。复发性脱位组报告了32％的重复手术率以解决不稳定问题。这在统计上是显着的，p ＝ 0.0007。首次脱臼组的简单肩部测试（SST）得分为11.4。复发性脱位组的SST评分为11。p= 0.037，差异显着。结论：与外科手术前反复脱位的患者相比，初次脱位的术后失稳率和再手术率更低。各组之间的SST得分显着不同。年轻的运动性肩膀不稳患者应及早接受手术干预，以降低术后不稳定和再次手术的风险。

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