[논문]Clinical Outcome after Surgical Treatment of Recurrent Shoulder Dislocation with Small Bony Bankart

Kim, Jung-Han; Kim, Chang-Wan

doi:10.5397/cise.2015.18.3.144

Clinical Outcome after Surgical Treatment of Recurrent Shoulder Dislocation with Small Bony Bankart 원문보기

Clinics in shoulder and elbow, v.18 no.3, 2015년, pp.144 - 151

Kim, Jung-Han (Department of Orthopaedic Surgery, Busan Paik Hospital, Inje University College of Medicine) , Kim, Chang-Wan (Department of Orthopaedic Surgery, Busan Paik Hospital, Inje University College of Medicine)

Abstract ▼ AI-Helper

Background: The consensus is that a bony Bankart lesion shorter than 25% of the length of glenoid does not affect the clinical result; hence, such lesions were often neglected. However, small bony Bankart lesions are associated with various types of capsulolabral lesions. Methods: A total of 82 patients who had undergone arthroscopic capsulolabral lesion repair surgery for anterior shoulder dislocation were reviewed. The prevalence rates of early and late type of capsulolabral lesions were compared between a group of patients with and a group without small bony Bankart lesions. In addition, the types of accompanying capsulolabral lesion were analyzed according to the type of bony Bankart lesion. Finally, the clinical outcomes were evaluated (active range of motion, American Shoulder and Elbow Surgeons score and Rowe's score). Results: Among the 13 patients who had small bony Bankart lesions, the prevalence rate of early and late type of capsulolabral lesions was 38.5% and 61.5%, respectively. Among the 69 patients without bony Bankart lesion, the prevalence rates of early and late type of capsulolabral lesions were 74% and 26%, respectively. Significantly worse clinical outcome was observed for the group of patients with both small bony Bankart lesions and late type of capsulolabral lesion. Conclusions: More severe type of small bony Bankart lesion appears to be associated with late type of capsulolabral lesion. The significantly worse clinical outcome for patients with both small bony Bankart lesion and late type of capsulolabral lesion indicates that small bony Bankart lesions cannot always be neglected.

주제어

AI 본문요약
AI-Helper

* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.

제안 방법

Glenoid-side bony defects were evaluated by arthroscopy at the time of the operations. The capsulolabral lesions were evaluated by the arthroscopic findings recorded in the medical notes, X-ray (axillary view, west point view) and the results of preoperative magnetic resonance arthrography (MRA) or magnetic resonance imaging (MRI). The size of the Bankart lesion was estimated by X-ray (axillary view, west point view).
Hence, our study population is not representative of all patients with recurrent shoulder dislocation. The study also did not compare clinical outcomes between a patient group who underwent bony Bankart surgery and a group who underwent soft tissue surgery. Thus, we can only conclude that the patients with small bony Bankart and the late type of capsulolabral lesions showed the worst clinical outcomes.
Additional anchors were placed in a similar manner. The surgeon performed only soft tissue Bankart repair. Bony Bankart lesions, regardless of amount or length, were left in situ without repair or excision.

대상 데이터

SAS (SAS Institute, Cary, NC, USA) was used for statistical evaluations, and all statistical analyses were performed by a specialized biostatistician. The level of significance was set at 0.
Three arthroscopic portals were used. Arthroscopic evaluation of all associated intra-articular lesions was performed via a standard posterior portal.

이론/모형

At the follow-up, data on the patients’ active forward flexion, and external rotation at 90 degrees abduction were obtained in addition to the assessment using American Shoulder and Elbow Surgeons (ASES) score and the modified Rowe’s score.
Fisher’s test was used to compare the prevalence rate of the early and late forms of capsulolabral lesions, depending on the presence or absence of small bony Bankart lesions. The KruskalWallis test was used to compare the follow-up evaluation scores in the 4 different groups (group A-I, group A-II, group B-I. group B-II), and the Bonferroni test was used for post-hoc analysis.
The type of capsulolabral lesions in each patient in each group was evaluated using Habermeyer’s classification system, which outlines the chronological evolution of capsulolabral lesions.

성능/효과

However few studies on the relationship between the presence of small bony glenoid lesions shorter than 25% of the length of the glenoid and specific types of capsulolabral lesions have been reported. The hypotheses of our study were 1) the different types of capsulolabral lesions would be seen, depending on the presence or absence of a bony Bankart lesion less than 25% of the glenoid rim deficiency, 2) patients with such small bony lesions concomitant with a specific type of capsulolabral lesion would show inferior clinical outcomes after arthroscopic Bankart repair. The purpose of this study was to compare the frequencies of different capsulolabral lesions depending on the presence or absence of a bony Bankart lesion²¹⁾ and to compare the clinical outcomes among groups who were subdivided according to the presence or absence of a bony Bankart lesion and the type of accompanying capsulolabral lesion.
5%). Based on the results, there is a high probability that bony Bankart lesions will be accompanied by the late type of capsulolabral lesions. In addition, all patients with type I bony Bankart lesions and one patient with a type II bony Bankart lesion had early capsulolabral lesions, such as Perthes and Bankart.

후속연구

However, the senior author performed soft tissue repair only for cases with concomitant small bony Bankarts because this course of action was clinically recommended at the time. The results of this study suggest otherwise, and further study on small bony Bankarts will refine clinical recommendations. This study also did not assess the amount of glenoid defect, although we suggest that loss of bony buttress compromises the stability of the shoulder to a noticeable degree.

참고문헌 (27)

Robinson CM, Dobson RJ. Anterior instability of the shoulder after trauma. J Bone Joint Surg Br. 2004;86(4):469-79.

상세보기
Simonet WT, Melton LJ 3rd, Cofield RH, Ilstrup DM. Incidence of anterior shoulder dislocation in Olmsted County, Minnesota. Clin Orthop Relat Res. 1984;(186):186-91.
Bui-Mansfield LT, Banks KP, Taylor DC. Humeral avulsion of the glenohumeral ligaments: the HAGL lesion. Am J Sports Med. 2007;35(11):1960-6.

상세보기
Fujii Y, Yoneda M, Wakitani S, Hayashida K. Histologic analysis of bony Bankart lesions in recurrent anterior instability of the shoulder. J Shoulder Elbow Surg. 2006;15(2):218-23.

상세보기
Gerber C, Nyffeler RW. Classification of glenohumeral joint instability. Clin Orthop Relat Res. 2002;(400):65-76.
Habermeyer P, Gleyze P, Rickert M. Evolution of lesions of the labrum-ligament complex in posttraumatic anterior shoulder instability: a prospective study. J Shoulder Elbow Surg. 1999; 8(1):66-74.

상세보기
Mizuno N, Yoneda M, Hayashida K, Nakagawa S, Mae T, Izawa K. Recurrent anterior shoulder dislocation caused by a midsubstance complete capsular tear. J Bone Joint Surg Am. 2005;87(12):2717-23.

상세보기
Taylor DC, Arciero RA. Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first-time, traumatic anterior dislocations. Am J Sports Med. 1997;25(3):306-11.

상세보기
Bigliani LU, Newton PM, Steinmann SP, Connor PM, Mcllveen SJ. Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med. 1998;26(1):41-5.

상세보기
Black KP, Lim TH, McGrady LM, Raasch W. In vitro evaluation of shoulder external rotation after a Bankart reconstruction. Am J Sports Med. 1997;25(4):449-53.

상세보기
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 lesion. Arthroscopy. 2000;16(7):677-94.

상세보기
Greis PE, Scuderi MG, Mohr A, Bachus KN, Burks RT. Glenohumeral articular contact areas and pressures following labral and osseous injury to the anteroinferior quadrant of the glenoid. J Shoulder Elbow Surg. 2002;11(5):442-51.

상세보기
Hovelius LK, Sandstrom BC, Rosmark DL, Saebo M, Sundgren KH, Malmqvist BG. Long-term results with the Bankart and Bristow-Latarjet procedures: recurrent shoulder instability and arthropathy. J Shoulder Elbow Surg. 2001;10(5):445-52.

상세보기
Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: a cadaveric study. J Bone Joint Surg Am. 2000; 82(1):35-46.

상세보기
Lazarus MD, Sidles JA, Harryman DT 2nd, Matsen FA 3rd. Effect of a chondral-labral defect on glenoid concavity and glenohumeral stability. A cadaveric model. J Bone Joint Surg Am. 1996;78(1):94-102.

상세보기
Pouliart N, Marmor S, Gagey O. Simulated capsulolabral lesion in cadavers: dislocation does not result from a bankart lesion only. Arthroscopy. 2006;22(7):748-54.

상세보기
Speer KP, Deng X, Borrero S, Torzilli PA, Altchek DA, Warren RF. Biomechanical evaluation of a simulated Bankart lesion. J Bone Joint Surg Am. 1994;76(12):1819-26.

상세보기
Zuckerman JD, Gallagher MA, Cuomo F, Rokito A. The effect of instability and subsequent anterior shoulder repair on proprioceptive ability. J Shoulder Elbow Surg. 2003;12(2):105-9.

상세보기
Yiannakopoulos CK, Mataragas E, Antonogiannakis E. A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Arthroscopy. 2007;23(9):985-90.

상세보기
Boileau P, Villalba M, Hery JY, Balg F, Ahrens P, Neyton L. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am. 2006;88(8):1755-63.

상세보기
Apreleva M, Hasselman CT, Debski RE, Fu FH, Woo SL, Warner JJ. A dynamic analysis of glenohumeral motion after simulated capsulolabral injury. A cadaver model. J Bone Joint Surg Am. 1998;80(4):474-80.

상세보기
Balg F, Boileau P. The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br. 2007;89(11):1470-7.
Lauman U. Kinesiology of the shoulder joint. In: Kobel R, ed. Shoulder replacement. New York: Springer Verlag; 1987.
Lippitt SB, Vanderhooft JE, Harris SL, Sidles JA, Harryman DT 2nd, Matsen FA 3rd. Glenohumeral stability from concavitycompression: a quantitative analysis. J Shoulder Elbow Surg. 1993;2(1):27-35.

상세보기
Malicky DM, Soslowsky LJ, Blasier RB, Shyr Y. Anterior glenohumeral stabilization factors: progressive effects in a biomechanical model. J Orthop Res. 1996;14(2):282-8.

상세보기
Novotny JE, Nichols CE, Beynnon BD. Kinematics of the glenohumeral joint with Bankart lesion and repair. J Orthop Res. 1998;16(1):116-21.

상세보기
Mologne TS, Provencher MT, Menzel KA, Vachon TA, Dewing CB. Arthroscopic stabilization in patients with an inverted pear glenoid: results in patients with bone loss of the anterior glenoid. Am J Sports Med. 2007;35(8):1276-83.

상세보기

표제어: PCR

동의어: Packet Collision Rate

용어 설명 출처 목록 (6)

용어 설명: PCR은 세균 특이성이 있는 primer를 이용하여 적은 수의 세균이 있을지라도 쉽게 검출할 수 있는 유용한 방법이며, 이를 이용하여 구강 내 치면세균막이나 타액에서 직접 세균을 검출할 수 있게 되었다[8].

내보내기 구분	파일저장 인쇄 메일전송
구성항목	기본정보 상세정보 관리번호, 논문명, 저널/프로시딩명, 저자 , 발행년, 권, 호, 시작페이지, 끝페이지, 발행기관 관리번호, 논문명, 대등논문명, 저자 , 저널/프로시딩명, 발행기관, 발행년, 발행언어, 권, 호, 시작페이지, 끝페이지, ISBN, ISSN, 주제분야, 키워드, 초록(한글), 초록(영문), 저자(소속기관)
저장형식	Text(ASCII format) Excel format RefWorks Direct Export RIS format (for Reference Manager, ProCite, EndNote), Scholar's Aids, Mendeley
메일정보	받는사람 (필수) @ 보내는사람 (선택) @ 제목 내용 KISTI 검색결과 이메일 서비스
안내	총 건의 자료가 검색되었습니다. 다운받으실 자료의 인덱스를 입력하세요. (1-10,000) 검색결과의 순서대로 최대 10,000건 까지 다운로드가 가능합니다. 데이타가 많을 경우 속도가 느려질 수 있습니다.(최대 2~3분 소요) 다운로드 파일은 UTF-8 형태로 저장됩니다. 파일의 내용이 제대로 보이지 않을실 때는 웹브라우저 상단의 보기 -> 인코딩 -> 자동선택 여부를 확인하십시오. ~ Text(ASCII format) Excel format

연합인증