Surgical Trends in Bankart Repair An Analysis of Data From the American Board of Orthopaedic Surgery Certification Examination
Surgical Trends in Bankart Repair An Analysis of Data From the American Board of Orthopaedic Surgery Certification Examination
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DOI：
10.1177/0363546511406869
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发表时间：
2011-09-01
影响因子：
4.8
通讯作者：
Wolf, Jennifer Moriatis
中科院分区：
文献类型：
--
作者：
Owens, Brett D.;Harrast, John J.;Wolf, Jennifer Moriatis
背景：关节镜下Bankart修复术是20世纪90年代出现的一种替代开放修复的微创方法。结论：回顾美国骨科委员会(ABOS)的数据将显示关节镜下Bankart手术与开放Bankart手术相比有增加的趋势。研究设计：描述性流行病学研究。方法：对2003年至2008年所有开放或关节镜下Bankart修复病例进行ABOS数据库查询，因为2003年引入了关节镜修复的CPT(当前程序术语)代码。对关节镜下Bankart修补术(29806例)或开放Bankart修复术(23455例)采用CPT码编码的病例进行复习。获得更多关于外科医生(手术年份、地理位置、奖学金培训、专科检查区域)以及患者(年龄、性别、随访时间、并发症、客观结果指标[疼痛、畸形、功能和满意度])的数据。结果：2003-2008年间，共报告了4562例Bankart修复病例，占ABOS数据库中肩部手术病例总数的8.6%。从2003年到2005年，71.2%的Bankart修复是在关节镜下进行的，而在2006年到2008年，这一比例为87.7%(P<；.0001)。接受过运动医学专业培训的外科医生完成了大部分(65.3%)的Bankart修复手术。在整个研究期间，接受过体育培训的外科医生进行关节镜下修复的比例(84.1%)也高于未受过培训的外科医生(71.9%)(P<；0.0001)。然而，到2008年，在90%的病例中，未接受团契训练的外科医生和接受运动医学团契训练的外科医生都进行了关节镜下修复。从2003年到2008年，东北地区的外科医生在关节镜下进行Bankart修复的比例(84.7%)明显高于其他地区的外科医生(78.6%)(P<；.0001)。最常见的并发症是神经麻痹/损伤和脱位，开放组的神经损伤率为2.2%，关节镜组为0.3%(P<；.0001)，开放稳定组的脱位率为1.2%，关节镜组为0.4%(P=.0039)。结论：回顾ABOS的数据显示，随着时间的推移，关节镜下肩关节稳定的趋势，开放修复的使用减少。与开放手术相比，关节镜稳定组的并发症总体较低。
Background: Arthroscopic Bankart repair emerged in the 1990s as a minimally invasive alternative to open repair. The optimal technique of surgical stabilization of the unstable glenohumeral joint remains controversial.Hypothesis: A review of the American Board of Orthopaedic Surgery (ABOS) data would show a trend toward an increasing number of arthroscopic versus open Bankart procedures.Study Design: Descriptive epidemiology study.Methods: A query of the ABOS database for all cases of open or arthroscopic Bankart repair from 2003 through 2008 was performed, as the CPT (Current Procedural Terminology) codes for arthroscopic repair were introduced in 2003. All cases coded with CPT codes for arthroscopic Bankart repair (29806) or open Bankart repair (23455) were reviewed. Additional data were obtained on the surgeons (year of procedure, geographic location, fellowship training, subspecialty examination area) as well as the patients (age, gender, follow-up length, complications, objective outcome measures [pain, deformity, function, and satisfaction]).Results: From 2003 to 2008, a total of 4562 Bankart repair cases were reported, composing 8.6% of the total number of shoulder surgery cases in the ABOS database. From 2003 to 2005, 71.2% of Bankart repairs were arthroscopic, compared with 87.7% between 2006 and 2008 (P < .0001). Surgeons having obtained subspecialty training in sports medicine performed the majority (65.3%) of Bankart repairs. Over the entire period, sports-trained surgeons also performed a higher proportion of arthroscopic repairs (84.1%) compared with surgeons without this training (71.9%) (P < .0001). However, by 2008 both non-fellowship-trained and sports medicine fellowship-trained surgeons performed arthroscopic repair in 90% of cases. Surgeons in the Northeast region performed a significantly greater proportion of arthroscopic Bankart repairs (84.7%) than did surgeons in other regions (78.6%) (P < .0001) from 2003 to 2008. The most commonly reported complications were nerve palsy/injury and dislocation, with a rate of nerve injury of 2.2% in the open group compared to 0.3% in the arthroscopic group (P < .0001), and dislocation rate of 1.2% with open stabilization compared with 0.4% arthroscopically (P = .0039).Conclusion: Review of the ABOS data shows a trend toward arthroscopic shoulder stabilization over time, with the use of open repair declining. Reported complications were lower overall in the arthroscopic stabilization group when compared with open surgeries.