[Effectiveness of a single threaded anchor fixation under shoulder arthroscopy in treatment of fresh bony Bankart injury].

抄録

Objective: To investigate the effectiveness of a single threaded anchor fixation under shoulder arthroscopy in the treatment of fresh bony Bankart injury.

Methods: Between January 2017 and May 2021, 12 patients with fresh bony Bankart injury caused by trauma were treated with a single threaded anchor fixation under shoulder arthroscopy. There were 10 males and 2 females with an average age of 38.8 years (range, 21-64 years). The time between injury and operation ranged from 7 to 30 days (mean, 15.8 days). Preoperative American Shoulder and Elbow Surgeons (ASES) score was 44.9±17.4, the University of California at Los Angeles (UCLA) score was 13.1±5.5; the forward supination, lateral external rotation, and lateral internal rotation of shoulder were (130.8±11.8)°, (25.0±7.9)°, and 9.2±1.6, respectively. CT scan and three-dimensional (3D) reconstruction showed that the fracture fragment area was less than 1/4 of the glenoid area in 10 cases, and 1/4-1/2 in 2 cases. The operation time was recorded. During follow-up, ASES score, UCLA score, Rowes score, and shoulder range of motion were used to evaluate the effectiveness, and shoulder CT scan and 3D reconstruction were used to evaluate the fracture position and healing.

Results: The operation time ranged from 50 to 150 minutes (mean, 85.5 minutes). All patients were followed up 3-18 months (mean, 9.1 months). There was no serious adverse effect such as infection, re-dislocation, or thrombosis. Three patients had shoulder adhesions after operation. At last follow-up, the forward supination of shoulder [(162.1±30.3)°], lateral external rotation [(37.5±11.2)°], and lateral internal rotation (9.2±1.6) significantly improved when compared with those before operation ( =3.331, =0.003; =3.153, =0.005; =2.716, =0.013). The ASES score was 89.7±11.8 and the UCLA score was 32.8±2.4, which significantly increased when compared with those before operation ( =7.368, <0.001; =11.370, <0.001). The Rowes score ranged from 75 to 100 (mean, 92.9). Among them, 9 cases were excellent and 3 cases were good, with an excellent and good rate of 100%. CT re-examination showed that the fracture line disappeared in 11 cases, and the fracture alignment was good; the alignment of the fracture fragment was poor in 1 case whose fracture fragment area was between 1/4 and 1/2 of the glenoid area.

Conclusion: For the fracture fragment area not exceeding 1/4 of the glenoid, the labrum-capsule complex at the lower end of the bone fragment intact, and the non-comminuted fresh bony Bankart injury, a single threaded anchor fixation under shoulder arthroscopy can achieve better effectiveness, has the advantages of less trauma and faster postoperative recovery.

目的: 探讨肩关节镜下单枚带线锚钉固定治疗新鲜骨性Bankart损伤疗效。.

方法: 2017年1月—2021年5月，使用肩关节镜下单枚带线锚钉固定治疗12例外伤导致的新鲜骨性Bankart损伤。男10例，女2例；年龄21～64岁，平均38.8岁。受伤至入院时间7～30 d，平均15.8 d。术前美国肩肘外科协会（ASES）评分（44.9±17.4）分，美国加州大学洛杉矶分校（UCLA）评分（13.1±5.5）分。肩关节活动度：前屈上举（130.8±11.8）°、体侧外旋（25.0±7.9）°、体侧内旋9.2±1.6。患肩CT扫描联合三维重建检查示，骨折块面积小于关节盂1/4 者10例，1/4～1/2者2例。记录手术时间，随访时以ASES评分、UCLA评分、Rowes评分以及肩关节活动度评价疗效，肩关节CT扫描及三维重建评估骨折位置和愈合情况。.

结果: 手术时间50～150 min，平均85.5 min。所有患者均获随访，随访时间3～18个月，平均9.1个月。术后3例发生肩关节粘连，无感染、血栓形成、肩关节再脱位等严重并发症发生。末次随访时，肩关节活动度：前屈上举（162.1±30.3）°、体侧外旋（37.5±11.2）°、体侧内旋7.8±0.8，均较术前改善（ =3.331， =0.003； =3.153， =0.005； =2.716， =0.013）。ASES评分为（89.7±11.8）分、UCLA评分为（32.8±2.4）分，与术前比较差异均有统计学意义（ =7.368， <0.001； =11.370， <0.001）。Rowes评分75～100分，平均92.9分；其中，优9例、良3例，优良率达100%。CT复查示11例骨折线消失，骨折对位可；1例骨折块面积介于关节盂1/4～1/2者骨折块对位欠佳。.

结论: 对于骨折块面积不超过关节盂1/4、骨折块下方盂唇-关节囊复合体完好、非粉碎性新鲜骨性Bankart损伤，经肩关节镜下单枚带线锚钉固定可获得较好疗效，具有手术创伤小、术后恢复快等优势。.