Objective: To investigate the mid-term effectiveness of arthroscopic Bankart repair for recurrent anterior shoulder dislocation.
Methods: The clinical data of 107 patients with recurrent anterior shoulder dislocation who met the inclusion criteria between January 2017 and June 2021 was retrospectively analyzed, and all patients underwent arthroscopic Bankart repair. There were 88 males and 19 females. The age of the primary dislocation ranged from 13 to 48 years (mean, 23.3 years). The number of preoperative dislocations was 2-160 times (median, 7 times). The duration of preoperative instability was 0.2-240.0 months (median, 36.0 months). The mean age at operation was 28.2 years (range, 16-61 years). There were 43 cases of left shoulder and 64 cases of right shoulder. The proportion of glenoid defects in 63 patients was 1.7%-16.1% (mean, 8.1%). MRI showed that none of the patients had rotator cuff tears or shoulder stiffness. The CT three-dimensional reconstruction was performed at 1 day after operation to evaluate the distribution of implanted anchors and the occurrence of glenoid split fracture and whether there were nails pullout at the implant site. The postoperative complications were observed, and the pain and function of the shoulder were evaluated by visual analogue scale (VAS) score, Rowe score, Constant-Murley score, and American Shoulder and Elbow Surgeons (ASES) score. The recurrence of instability, the results of apprehension test, the number of patients who returned to preoperative sports level, and the satisfaction rate of patients were recorded.
Results: All patients were successfully operated and were followed up 20-73 months (mean, 41.5 months). All incisions healed by first intention. The CT three-dimensional reconstruction at 1 day after operation showed that the anchors were located at the 2 : 00-5 : 30 positions of the glenoid, and there was no glenoid split fracture or nails pullout at the implant site. At last follow-up, VAS score was significantly lower than that before operation, and Rowe score, Constant-Murley score, and ASES score were significantly higher than those before operation ( P<0.05). Seven patients (6.5%) had recurrence of anterior shoulder dislocation at 23-55 months (mean, 39.9 months) after operation, including 6 cases of dislocation and 1 case of subluxation. At last follow-up, 51 patients (47.7%) returned to preoperative sports level, and 11 patients (10.3%) had a positive apprehension test. The patients' satisfaction rate was 90.7% (97/107). Among the 10 patients who were not satisfied with the surgical effectiveness, 7 patients had postoperative recurrence of instability, and 3 patients felt that they did not return to preoperative sports level.
Conclusion: Arthroscopic Bankart repair has good mid-term effectiveness in patients with recurrent anterior shoulder dislocations, minimal or no glenohumeral bone defects and low sports need.
目的: 探讨关节镜下Bankart修复术治疗复发性肩关节前脱位的中期疗效。.
方法: 回顾性分析2017年1月—2021年6月符合选择标准的107例复发性肩关节前脱位患者临床资料，均接受关节镜下Bankart修复术。男88例，女19例；患者初次脱位年龄13～48岁，平均23.3岁；脱位次数2～160次，中位次数7次；病程0.2～240.0个月，中位病程36.0个月。手术时年龄16～61岁，平均28.2岁。左肩43例，右肩64例。 63例合并关节盂骨缺损，骨缺损达1.7%～16.1%，平均8.1%。MRI检查示均不合并肩袖撕裂和肩关节僵硬。术后1 d行CT三维重建检查，评估植入锚钉分布以及锚钉植入处有无关节盂劈裂骨折和拔钉等情况发生。观察术后并发症发生情况，采用疼痛视觉模拟评分（VAS）、Rowe评分、Constant-Murley评分、美国肩肘外科医师协会（ASES）评分评估患肩疼痛及功能。记录术后患者肩关节不稳复发情况、恐惧试验结果、恢复至术前运动水平患者例数以及患者自评满意度。.
结果: 手术均顺利完成。患者均获随访，随访时间20～73个月，平均41.5个月。术后切口均Ⅰ期愈合。术后1 d CT三维重建检查示，锚钉均位于2∶00～5∶30区域且在关节盂表面边缘，无拔钉及锚钉植入处劈裂骨折发生。末次随访时，VAS评分低于术前，Rowe评分、Constant-Murley评分及ASES评分均较术前增高，差异有统计学意义（ P<0.05）。7例（6.5%）于术后23～55个月肩关节前脱位复发，平均39.9个月；其中脱位6例、半脱位1例。末次随访时，51例患者（47.7%）恢复至术前运动水平，11例（10.3%）恐惧试验阳性。患者自评满意率为90.7%（97/107）；10例手术效果不满意者中，7例术后肩关节不稳复发，3例自觉未恢复至术前运动水平。.
结论: 对于关节盂骨缺损少、运动需求不高的复发性肩关节前脱位患者，关节镜下Bankart修复术治疗可获得良好的中期疗效。.
Keywords: Bankart repair; Recurrent anterior shoulder dislocation; arthroscopy; mid-term effectiveness.