以Remplissage技术修复伴有Hill-Sachs缺损的Bankart损伤治疗复发性肩关节不稳

Arthroscopic Remplissage with Bankart repair for the treatment of recurrent shoulder instability with Hill-Sachs lesion

目的探讨关节镜下Bankart损伤修复联合Remplissage技术治疗Bankart损伤合并Hill-Sachs缺损的临床效果。方法 2007～2009年间因复发性肩关节前侧不稳接受关节镜下Bankart修复结合Rem-plissage手术治疗的20例患者纳入本研究。所有病例术前证实均存在Bankart损伤和明显的Hill-Sachs损伤。术后随访中采用WOSI评分、ASES评分及Penn肩关节评分评价患者的临床效果,并对肩关节不稳的复发情况进行评估。结果所有患者的平均随访时间为25个月(18～32个月)。最终随访发现3例(15%)发生复发性肩关节脱位,随着随访期延长,脱位情况逐渐减少。末次随访时的平均ASES肩关节评分为92.5,平均Penn肩关节评分为90.0,平均WOSI评分为572.5。在ASES、Penn以及WOSI评分方面,合并其它损伤患者与未存在其它合并伤患者之间差异无统计学意义(P>0.05)。结论关节镜下Bankar损伤修复联合Remplissage技术治疗Bankart损伤合并Hill-Sachs缺损的临床效果满意,可有效重建患者的肩关节功能。

Objective To investigate whether arthroscopic remplissage with Bankart repair is an effective treatment for patients with Hill-Sachs defects.Methods Between 2007 and 2009,20 patients underwent arthroscopic Bankart repair with remplissage for the treatment of recurrent anterior glenohumeral instability and large Hill-Sachs defects.Preoperative imaging in all patients demonstrated both a Bankart lesion and a significant Hill-Sachs defect.Patients were followed up postoperatively with the Western Ontario Shoulder Instability score（WOSI）,the American Shoulder and Elbow Surgeons score（ASES）,and the Penn Shoulder Score.Recurrent dislocation was documented.Results The mean length of follow-up in this study was 25 months（range,18 to 32 months）.At final follow-up,3 patients reported recurrence of instability.The mean American Shoulder and Elbow Surgeons score was 92.5.The mean Penn score was 90.The mean total Western Ontario Shoulder Instability score was 572.5.There was no statistical difference in ASES,Penn and WOSI shoulder scores for patients with concomitant injury.Conclusion For the Bankart lesions with Hill-Sachs defects,arthroscopic remplissage technique with Bankart repair can achieve satisfactory clinical results and effectively restore shoulder function.