關節(jié)鏡bankart修復用于慢性肱骨前盂不穩(wěn)定

1、ArthroscopicBony Bankart Repairfor Chronic Anterior Glenohumeral Instability,Funabashi Orthopaedic Sports Medicine Center,,Bony Bankart Lesion,Prevalence50% if evaluated by 3DCT40% erosion10% normalSugaya, JBJS-8

2、5A, 2003,Bony Bankart Lesion,TreatmentSoft tissue repairOpen bone-grafting if glenoid bone defect is large,,Large Glenoid Defect,3DCT & arthroscopyA bony fragment remains without smoothing out!,Bony Ban

3、kart Lesion,“Displaced” old avulsion fractureFragment connected firmly with the labrumForms a “Fragment-labroligamentous” complexRestoration of glenoid rim morphology may be possible!?,Purpose,To evaluate post-op outc

4、omes of an arthroscopic bony Bankart repair for chronic traumatic recurrent anterior glenohumeral instability,Subjects,Inclusion criteriaChronic traumatic recurrent anterior glenohumeral instabilityBony fragment confir

5、med both by 3DCT and during arthroscopic surgery,Subjects,42 shoulders in 41 patients37 males, 4 femalesAverage age at surgery22.9 yrs (range, 15-36)38 active sports participants30 contact/collision4 thrower,,Metho

6、ds,Quantification of bone lossInferior glenoid circle on 3DCTQuantification#1: Fragment size (%)Sugaya, JBJS, 2003#2: Defect rate (%)Lo, Arthroscopy, 2004,Quantification #1,Sugaya, et al. JBJS 85A, 2003.,,Fragment

7、size (%) =Area Fragment /Area Circle,,Quantification #2,Lo, et al. Arthroscopy, 2004.,,,,,,b,A,Defect rate (%) =b/Ab: defect widthA: circle diameter*Modified method described by Lo, e

8、t al.,Glenoid Bone Loss,#1: Average fragment size9.2% (range, 2.1-20.9)#2: Average defect rate24.8% (range, 11.4-38.6)22 more than 25%: inverted pear?20 less than 25%,Methods,General anesthesiaBeach-chair position

9、Bilateral EUADiagnostic arthroscopyArthroscopic stabilization using suture anchors,,Arthroscopic Appearance,34y, male,Posterior view,Anterior view,Complex Mobilization,Posterior view,Posterior view,After Bony Bankart R

10、epair,Posterior view,Posterior view,Post-op Schedule,Immobilization: 3 weeksIsometric muscle exercisesADL: 6 weeksSports activity: 3 monthsThrowing: 6 monthsCollision/contact: 6 months,Outcome Measures,The Rowe scor

11、eThe UCLA scorePre-op & at the final follow-up33 months (24-45) on averageSports returnStatistics,Results,Rowe score 33.6→94.5±13.9 (40-100)UCLA score20.5→33.6±2.5 (22-35)39 excellent or good (93%)

12、2 poor (4.8%),Results,Sports return36 (94.7%) returned to sports32 (84%) @ preinjury level4 (11%) @ lower level2 (5.3%) unable to returnsuffered re-injury,Results,2 failures (4.8%)1 non-compliant patient experienc

13、ed a redislocation 3 months post-op during soccer1 experienced a redislocation 12 months post-op during Rugby,Post-op 3DCT,,16y, male, baseball thrower,Post-op 3DCT,,16y, male, baseball player,Discussion,The inverted-pe

14、ar glenoidNot indicated for arthroscopyRequires open bone-graftingBurkhart, et al. Arthroscopy, 2000Minimum of 25 to 27% of the entire width of the inferior glenoidLo, et al. Arthroscopy, 2004,Discussion,The inverte

15、d-pear glenoidBony fragment present Size and shape variableSomewhere along the antero-inferior portion of the neckIf evaluated by 3DCTUnpublished data,Discussion,The present study 22 patients quantified with more t

16、han 25% of glenoid bone lossOutcome favorable Restoration of glenoid morphology through this technique works,Discussion,Fragment/labrum junction intactBlood supply can be preservedHistological studyFragment osteonec

17、rosis less likelyFujii, et al, JSES, 2000 Bony union can be expected,Discussion,Analysis of failureRe-injury before bony unionInitial fixation strengthPermanent strong suturesDouble loaded suture anchorsAugmentati

18、onRotator Interval closure, etc,Conclusions,Arthroscopic bony Bankart repair can provide a successful outcome even in shoulders with a significant bony defectThis technique could be an alternative for open bone-graftin

19、g in patients with a large glenoid defect,References,Bigliani LU, Newton PM, Steinmann SP, Connor PM, McIlveen SJ. Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med. 1998

20、;26:41-5.Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesi

21、on. Arthroscopy. 2000;16:677-94.Burkhart SS, DeBeer JF, Tehrany, AM, Parten PM. Quantifying glenoid bone loss arthroscopically in shoulder instability. Arthroscopy. 2002;18:488-91.FujiiY, Yoneda M, Miyazaki Y, Obata M,

22、 Wakiya S. Histological study of bony Bankart lesion in recurrent dislocation and subluxation of the shoulder. The Shoulder Joint (Katakansetsu). 2000;24:175-7. Japanese. J Shoulder Elbow Surg. 2000;9:457 (abstract).Gar

23、tsman GM, Taverna E, Hammerman SM. Arthroscopic rotator interval repair in glenohumeral instability: description of an operative technique. Arthroscopy. 1999; 15: 330-2.Gartsman GM, Roddey TS, Hammerman SM. Arthroscopic

24、 treatment of anterior-inferior glenohumeral instability. Two to five year follow-up. J Bone Joint Surg Am. 2000;82:991-1003.Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. The effect of a glenoid defect on anteroinferior

25、 stability of the shoulder after Bankart repair: A cadaveric study. J Bone Joint Surg Am. 2000; 82:35-46.,References,Karas SG. Arthroscopic rotator interval repair and anterior portal closure: an alternative technique. A

26、rthroscopy. 2002; 18: 436-9.Kim SH, Ha KI, Cho YB, Ryu BD, Oh I. Arthroscopic anterior stabilization of the shoulder: two to six-year follow-up. J Bone Joint Surg Am. 2003;85:1511-8.Lo, IY, Parten, PM, Burkhart, SS. Th

27、e inverted pear glenoid: an indicator of significant glenoid bone loss. Arthroscopy. 2004;20:169-74.Sugaya H, Moriishi J, Dohi M, Kon Y, Tsuchiya A. Glenoid rim morphology in recurrent anterior glenohumeral instability.

28、 J Bone Joint Surg Am. 2003; 85: 878-884.Sugaya H, Kon Y, Tsuchiya A. Arthroscopic Repair of Glenoid Fractures Using Suture Anchors: Technical Note with Cases Series. Arthroscopy. in press.Sugaya H, Kon Y, Tsuchiya A.

29、Arthroscopic Bankart repair in the beach-chair position: a cannulaless method using intra-articular suture relay technique. Arthroscopy. in press.Sugaya H, Kon Y, Matsuki K, Tsuchiya A. Arthroscopic superior labrum deta

30、chment repair using lateral acromial portal. Kasnsetsukyo (Arthroscopy). 2002;27:163-7. Japanese.Treacy SH, Field LD, Savoie FH. Rotator interval capsule closure: an arthroscopic technique. Arthroscopy. 1997; 13:103-6.,