Borderline Glenoid Bone Defect in Anterior Shoulder Instability Latarjet Procedure Versus Bankart Repair
Borderline Glenoid Bone Defect in Anterior Shoulder Instability Latarjet Procedure Versus Bankart Repair
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DOI：
10.1177/0363546518776978
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发表时间：
2018-07-01
影响因子：
4.8
通讯作者：
Rhee, Yong Girl
中科院分区：
文献类型：
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作者：
Jeon, Yoon Sang;Jeong, Ho Yeon;Rhee, Yong Girl
背景资料：肩关节前不稳定伴关节盂前缘边缘骨缺损（15%-20%）的最佳手术方法仍存在争议。目的：比较关节镜下Bankart修复术和Latarjet手术在复发性肩关节前不稳定伴关节盂边缘骨缺损患者中的临床结局和复发率。研究设计：队列研究;证据等级：3。方法：作者回顾性分析了关节镜下Bankart修复术和Latarjet手术治疗复发性肩关节前不稳定伴边界（15%-20%）关节盂骨缺损的病例。入组149例患者（Bankart组，n = 118; Latarjet组，n = 31）。平均随访时间和手术年龄为28.9 ± 7.3个月（范围：24-73个月）和26 +/- 5岁（范围，16-46岁）。罗和加州大学洛杉矶分校（加州大学，洛杉矶）肩关节评分从术前42.0 +/- 14.3和22.9 +/- 3.2显著改善至术后90.9 +/- 15.4和32.5 +/- 3.3 Latarjet组分别从41.0 +/- 17.9和22.3 +/- 3.4降至91.1 +/- 16.1和32.3 +/- 3.4（P < .001）。最终随访时，Rowe（P = .920）或UCLA（P = .715）评分无显著组间差异。Bankart组在前屈、外展外旋和后内旋期间的平均术后运动丧失为3.0 ° ± 6.2 °、11.6 ° ± 10.2 °和0.6个脊柱节段，Bankart组为3.7 ° ± 9.8 °、10.3 ° ± 12.8 °，Latarjet组为0.9节段。这些差异不显著。然而，Bankart组（13.3度+/- 12.9度）的侧面外旋损失明显大于Latarjet组（7.3度+/- 18.1度，P = 0.034）。Bankart组的总体复发率（22.9%）显著高于Latarjet组（6.5%）（P = 0.040）。结论：Latarjet手术和关节镜下Bankart修复术均为肩关节前不稳定伴边缘性关节盂骨缺损提供了令人满意的临床结局评分和疼痛缓解。然而，Latarjet手术导致的复发率显著低于关节镜下Bankart修复术，外旋限制也更少。因此，Latarjet手术可能是治疗伴有边界性关节盂骨缺损的前路复发性不稳定的更可靠的手术选择。
Background: The optimal procedure for anterior shoulder instability with a borderline (15%-20%) bone defect on the anterior rim of the glenoid is still controversial.Purpose: To compare the clinical outcome and recurrence rate between the arthroscopic Bankart repair and Latarjet procedure among patients with recurrent anterior shoulder instability and a borderline glenoid bone defect.Study Design: Cohort study; Level of evidence, 3.Methods: The authors retrospectively reviewed cases of arthroscopic Bankart repair and the Latarjet procedure for recurrent anterior shoulder instability with a borderline (15%-20%) glenoid bone defect. Enrollment comprised 149 patients (Bankart group, n = 118; Latarjet group, n = 31). The mean follow-up and age at operation were 28.9 +/- 7.3 months (range, 24-73 months) and 26 +/- 5 years (range, 16-46 years), respectively.Results: Rowe and UCLA (University of California, Los Angeles) shoulder scores significantly improved from 42.0 +/- 14.3 and 22.9 +/- 3.2 preoperatively to 90.9 +/- 15.4 and 32.5 +/- 3.3 postoperatively in the Bankart group (P < .001) and from 41.0 +/- 17.9 and 22.3 +/- 3.4 to 91.1 +/- 16.1 and 32.3 +/- 3.4 in the Latarjet group (P < .001), respectively. There were no significant between-group differences in Rowe (P = .920) or UCLA (P = .715) scores at the final follow-up. Mean postoperative loss of motion during forward flexion, external rotation in abduction, and internal rotation to the posterior was 3.0 degrees +/- 6.2 degrees, 11.6 degrees +/- 10.2 degrees, and 0.6 spinal segment in the Bankart group and 3.7 degrees +/- 9.8 degrees, 10.3 degrees +/- 12.8 degrees, and 0.9 spinal segment in the Latarjet group, respectively. These differences were not significant. However, the loss of external rotation at the side was significantly greater in the Bankart group (13.3 degrees +/- 12.9 degrees) than in the Latarjet group (7.3 degrees +/- 18.1 degrees, P = .034). The overall recurrence rate was significantly higher in the Bankart group (22.9%) than in the Latarjet group (6.5%), (P = .040).Conclusion: The Latarjet procedure and arthroscopic Bankart repair both provided satisfactory clinical outcome scores and pain relief for anterior shoulder instability with a borderline glenoid bone defect. However, the Latarjet procedure resulted in significantly lower recurrences and less external rotation limitation than the arthroscopic Bankart repair. Therefore, the Latarjet procedure could be a more reliable surgical option in anterior recurrent instability with a borderline glenoid bone defect.