运动医学未翻

ArthroscopicBankartRepair.IsItSuperiorToOlderSurgicalProceduresForShoulderInstability?Authors:MetwallyShaheen:ConsultantOrthopedicSurgery,SaudiGermanHospitalJeddah;SaudiArabiaMostafaAzab:LecturerofOrthopedicSurgery,CairoUniversity;EgyptEnjieIbrahim:DepartmentofOrthopedicSurgery,SaudiGermanHospitalJeddah,SaudiArabiaAbstractID:40332Theshoulderjointisthemostcommonlydislocatedjoint,withadocumentedincidenceof1.7%.

Recurrentinstabilityfollowinganepisodeofdislocationiscommon,especiallyintheyoungandactiveagegroups.

Recurrentinstabilityaffects50%to96%ofpatientswhofirstdislocateundertheageof20yearsandin40%to74%ofpatientsbetweentheagesof20and40years.[4]IntroductionThehighincidenceofrecurrentdislocationhasimplicationsfortheindividualandforsocietybecausechronicinstabilityofthejointmaypreventtheindividualfromgainingemploymentorworkingathisorherpotential.Evolutionofshoulderinstabilitysurgerythroughoutthelastcenturyreacheditssummitwithintroductionofarthroscopyformanaginglabraltearsandcapsularlaxity.IntroductionThisstudywasimplementedtoevaluatearthroscopicBankartrepairinfaceofopenBankartandopenLatarjetproceduresconcerningdegreeofstability,functionaleandcomplications.AimofStudy75shoulderinstabilitycaseschosenfromthehospitalmedicalrecordsandweredividedintothreegroups;eachconsistingof25patients:Group1:treatedbyarthroscopicBankartrepairGroup2:treatedbyopenBankartrepairGroup3:treatedbyLatarjetprocedureforcoracoidtransfer.Pre-operatively;allpatientswereevaluatedclinicallyforsignsofanteriorinstability.MagneticResonanceImaging(M.R.I)ArthrogramwaspreformedonallpatientstodocumenttheanteroinferiorlabraltearandassesstheHillSach’slesionMaterialAndMethodsMaterialsAllpatientswereoperatedintheperiodbetween2004and2007bythesamesurgeonandthestudywasconductedinFebruary2014.MaterialAndMethodsMethodsPost-operatively,allpatientswerekeptinanarmslingfor2-3weeksfollowedby1weekofpendulumexercises.Anoutlinedphysicaltherapyprogramwascommencedbyweek4to5.Returntodailyactivatesisafter3months.Sportsareresumedafter6to9monthsaccordingtothetypeofsportplayed.Patientswerefollowedupevery3monthsforaminimumof2years.Constantshoulderscorewasusedforevaluationofthefunctionaleduringthelastvisit.MaterialAndMethodsMethodsIngroup1:3caseswerefoundtohaveredislocationandonecaseofclinicalsubluxationwhichwerealltreatedbylatarjetcoracoidtransfer.Constantscorerevealed:20cases(80%)excellent2cases(8%)good3cases(12%)fairtopoore.Noimmediatepostoperativecomplicationswererecorded.

ResultsResults-Group1Pre-operativeMRI-RtshoulderBankartlesionArthroscopicimagesofanchorplacementImmediatePostoperativex-rayResults-Group1InGroup2:Onecaseofre-dislocation.ConstantScorerevealed:21cases(84%)excellent4cases(16%)goodNofairorpoorresults.Onecaseofdeepinfectiontreatedbywounddebridementandwash.

ResultsResults-Group2Pre-operativeMRI-RtshoulderBankartlesionImmediatePostoperativex-rayResults-Group2InGroup3:Onecaseofre-dislocation.Constantscorerevealed:20cases(80%)excellent5cases(20%)goodNofairorpoorresults.Onecasedevelopedpostoperativebrachialplexustractioninjurythatrecoveredspontaneouslyin7weeks.ResultsResults-Group3Pre-operativeMRI-LtshoulderBankartlesionandlargeHillSach’slesionImmediatePostoperativex-rayResults-Group3Limitationsofourstudyinclude;smallsamplenumber,shortfollow-upperiodandbeingretrospective.Lenters[2]etalnoteda2.27relativeriskofrecurrentinstability,a2.74RRofrecurrentdislocationandaRRof2.23forreoperationinpatientsundergoingarthroscopicstabilizationwhencomparedtothosetreatedbyopentechniques.Thisresultsupportsthere-dislocationratedocumentedinourarthroscopicallytreatedgroupofpatients.Bottonietal[1]

andSperberetal

foundnosignificantdifferenceintherangeofmotionbetweenpatientsintheeitherarthroscopicoropentreatmentgroups.Thiseisalsosimilartoourswithbothgroupshavingequalrangeofmotioninalldirections.DiscussionJoregensenetalfoundthat85.7%ofpatientsinthearthroscopicgroupand100%ofpatientsintheopengroupreturnedtopreinjuryactivitylevels.

However,7patientsinthearthroscopicgroupand8patientsintheopengroupdidsowithsomerestrictionsintheformofinabilitytoresumesports.[3]Inourseries;allpatientsreturnedtopre-injuryactivitylevelsinallthreegroupswithafasterreturnratebythearthroscopicgroup.DiscussionConcerningstability,openproceduresshowsuperiorityoverarthroscopicBankartrepairwithnosignificantdifferenceinlongtermfunctionaleandcomplicationsbetweenthearthroscopicandtheopenproceduresforshoulderinstability.ConclusionReferences1.

BottoniCR,SmithEL,BerkowitzMJ,TowleRB,MooreJH.

Arthroscopicversusopenshoulderstabilizationforrecurrentanteriorinstability:aprospectiverandomizedclinicaltrial.

AmJSportsMed.2006;34:1730-1737

2.

LentersTR,FrantaFM,LeopoldSS,MatsenFA.

Arthrosco