外傷性肩関節前方不安定症に対する補強措置を行わない鏡視下 Bankart 法（suture anchor法）の短期術後成績
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概要
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The purpose of this study was to evaluate the clinical results after arthroscopic Bankart repair (suture anchor technique) for traumatic anterior instability of the shoulder. We evaluated 23 shoulders (20 males and 3 females) treated with arthroscopic Bankart procedure. The average age at operation was 24.0 (15-36) years old. The average follow-up period was 34.2 (12-68) months. Clinical evaluation included rate of recurrent instability and range of motion (external rotation at anatomical and 90° abduction). All patients were assessed by the scoring systems of JSS-SIS (Japan Shoulder Society Shoulder Instability Score) and Rowe score in preoperative examination and at the final evaluation. In addition, 3D-CT imaging was performed for evaluating bone morphology (anterior bone defect). Statistical analysis of data was performed using Mann-Whitney U test. There was 1 repetitive redisloaction and 3 one time resubluxation (total 17.4%). There were 6 cases (26.1%) of bony Bankart lesions, and 17 cases (73.9%) of erosion or compression of the anterior glenoid. Recurrent cases had major trauma associated with the activity of contact and collision sports and/or bone defect of the anterior glenoid over 30% by 3D-CT. Postoperative mild limitations of external rotation at anatomical a nd 90° abduction were 5.7 ± 5.8° and 9.2 ± 6.3°, respectively. The average JSS-SIS was improved significantly from 59.1 ± 6.2 points preoperatively to 93.6 ± 9.6 points postoperatively, the average Rowe score was improved significantly from 36.5 ± 9.4 points preoperatively and 87.1 ± 20.9 points postoperatively. The recurrent rate was 17.4% after arthroscopic Bankart repair in our cases. These recurrence cases related to risk factor of recurrent instability after arthroscopic operation, for example, major trauma associated with an activity of contact and collision sports and/or bone defect of anterior glenoid over 30%. This study suggested that high-risk patients needed to add augmentation to the original technique.
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