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

Arthroscopic Bankart repair with suture anchors ： results and risk factors of recurrence of instability

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．g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。

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 artbroscopic 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, andathlete 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.