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One Anchor Double Fixation (OADF) Technique for Arthroscopic Bony Bankart Repair

두가닥의 봉합사를 가진 봉합나사못을 이용한 새로운 관절경적 골성 방카르트 병변 봉합술

  • Choi, Eui-Sung (Department of Orthopedic Surgery, College of Medicine, Chungbuk National University) ;
  • Park, Kyoung-Jin (Department of Orthopedic Surgery, College of Medicine, Chungbuk National University) ;
  • Kim, Yong-Min (Department of Orthopedic Surgery, College of Medicine, Chungbuk National University) ;
  • Kim, Dong-Soo (Department of Orthopedic Surgery, College of Medicine, Chungbuk National University) ;
  • Shon, Hyun-Chul (Department of Orthopedic Surgery, College of Medicine, Chungbuk National University) ;
  • Cho, Byung-Ki (Department of Orthopedic Surgery, College of Medicine, Chungbuk National University) ;
  • Bae, Seung-Hwan (Department of Orthopedic Surgery, College of Medicine, Chungbuk National University)
  • 최의성 (충북대학교 의과대학 정형외과학교실) ;
  • 박경진 (충북대학교 의과대학 정형외과학교실) ;
  • 김용민 (충북대학교 의과대학 정형외과학교실) ;
  • 김동수 (충북대학교 의과대학 정형외과학교실) ;
  • 손현철 (충북대학교 의과대학 정형외과학교실) ;
  • 조병기 (충북대학교 의과대학 정형외과학교실) ;
  • 배승환 (충북대학교 의과대학 정형외과학교실)
  • Received : 2010.04.16
  • Accepted : 2010.06.02
  • Published : 2010.06.15

Abstract

Purpose: The aim of this study was to evaluate the usefulness of arthroscopic Bony Bankart repair using a One Anchor Double Fixation Technique. Materials and Method: Seventeen patients with a Bony Bankart lesion were treated using the One Anchor Double Fixation Technique (OADF Technique). There were 13 males and 4 females. The average age was 24 years (range 17-42). The average follow-up period was 22.3 months. One 3.0 mm suture anchor with doubly loaded sutures was inserted into the glenoid rim. One suture strand was passed the around the small bony fragment and tied first. Another suture strand was passed through the capsule and tied over the bony fragment. The result was measured using Rowe's evaluation index & KSS score. The glenoid defect & bony fragment were measured by 3D-CT scan. Results: Rowe's evaluation index on the final follow-up showed an overall improvement from an average of 54 (range, 23-71) to 83.4 (range 71-90). Of the 17 cases, 13 were excellent, 3 were good, and 1 was fair. KSS scores showed improvement from an average of 71 (range 49-82) to 92.5 (range 82-94). There were no cases where pain continued to the final follow-up, and no cases being re-dislocated during the follow-up period. For six cases, we confirmed the bony healing of the bony Bankart lesion by CT. Conclusion: Bony Bankart lesion repair using this new method achieves excellent clinical results with low recurrence rates and is considered another choice for bony Bankart lesions.

목적: 골성 방카르트 병변이 있는 견관절 외상성 전방 불안정성 환자에서 두 가닥의봉합사를 가진 생체 흡수성 봉합 나사못를 이용한 새로운 수술 방법에 의한 관절경적 봉합술의 유용성을 알아보고자 한다. 대상 및 방법: 2005년 1월부터 2009년 3월까지 골성 방카르트 병변 봉합 술을 시행한 환자 중 12개월 이상 추시가 가능하였던 (평균 추시 기간 22.3개월, 범위 13~47개월) 17예를 대상으로 하였다. 남자 13예, 여자 4예였고, 우측이 14예 좌측이 3예였다. 평균 연령은 24세 (범위 17-42세)였다. 수상 시에서 수술까지의 기간은 평균 2년 (범위, 10개월-4년 1개월)이었다. 수술 방법은 두 가닥의 봉합사를 가진 봉합 나사못을 골편이 떨어진 관절 와에 고정한 후 하나의 봉합사를 골편을 둘러싸 고정 시킨 후 또 다른 봉합사를 이용하여 주변 관절 낭을 떠서 고정한 골편을 둘러 싼 후 봉합하였다. 술 후 결과는 Rowe의 평가 방법과 KSS 평가지수를 이용하였고 관절 와의 결손부위와 골편은 삼차원 입체 컴퓨터 단층 촬영을 이용하여 측정하였다. 결과: 수술 후 최종 추시상 Rowe 견관절 평가지수는 평균 54점 (범위 23~71점)에서 83.4점 (71~90점)으로 전반적으로 향상되었고, 전체적으로 우수 13예 (76%), 양호 3예 (18%), 보통 1예 (6%)였다. KSS 점수는 수술 전 평균 71점 (범위 49~82점)에서 수술 후 92.5점 (범위 82~94점)으로 향상하였다. 최종 추시상 통증이 지속되는 예는 없었으며, 추시기간 동안 재 탈구 된 예는 없었다. 수술 후 삼차원 입체 컴퓨터 단층 촬영이 시행되었던 6예에서 골 유합을 확인할 수 있었다. 결론: 견관절 외상성 불안정성에 대한 골성 방카르트 병변의 두 가닥의 봉합사를 가진 생체 흡수성 봉합나사못을 이용한 새로운 수술 방법에 의한 골성 방카르트 병변 봉합술은 우수한 임상결과와 낮은 재발율을 보이고, 합병증이 낮아 골성 방카르트 병변의 치료에 하나의 대안이 될 수 있을 것이라 사료 된다.

Keywords

References

  1. Adams JC: Recurrent dislocation of the shoulder. J Bone Joint Surg Br, 1: 26-38, 1948.
  2. Bigliani LU, Newton PM, Steinmann SP, Connor PM, Mcllveen SJ: Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sport Med, 26: 41-45, 1998.
  3. Burkhart SS, De Beer JF: Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the invertedpear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy, 16: 677-694, 2000. https://doi.org/10.1053/jars.2000.17715
  4. Huysmans PE, Haen PS, Dhert WJ, Willems WJ: The shape of the inferior part of the glenoid: a cadaveric study. J Shoulder Elbow Surg, 15: 759-763, 2006. https://doi.org/10.1016/j.jse.2005.09.001
  5. Huysmans PE, Haen PS, Kidd M, Dhert WJ, Van der hulst VP, Willems WJ: Quantification of a glenoid defect with three-dimensional computed tomography and magnetic resonance imaging a cadaveric study. J Shoulder Elbow Surg, 16: 803-809, 2007. https://doi.org/10.1016/j.jse.2007.02.115
  6. 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, 82: 35-46, 2000.
  7. Kim JH: Physical Examination of Shoulder Instability. J Korean Shoulder Elbow Soc, 11: 1-5, 2008. https://doi.org/10.5397/CiSE.2008.11.1.001
  8. Kim KC, Rhee KJ: Arthroscopic three-point doublerow repair acute bony bankart lesion. Knee Surg Sports Traumatol Arthrosc, 17: 102-106, 2009. https://doi.org/10.1007/s00167-008-0659-y
  9. Kon Y, Shiozaki H, Sugaya H: Arthroscopic repair of a humeral avulsion of the glenohumeral ligament lesion. Arthroscopy, 21: 632, 2005.
  10. Millett P, Braun S: The “Bony Bankart bridge”Procedure: A New Arthroscopic Technique for Reduction and Internal Fixation of a Bony Bankart Lesion. Arthroscopy, 25: 102-105, 2009. https://doi.org/10.1016/j.arthro.2008.07.005
  11. Porcellini G, Campi F, Paladini P: Arthroscopic approach to acute bony Bankart lesion. Arthroscopy, 18: 764-769, 2002. https://doi.org/10.1053/jars.2002.35266
  12. Resch H, Wykypiel HF, Maurer H, Wambacher M: The anteroinferior (transmuscular) approach for arthroscopic repair of the Bankart lesion: an anatomic and clinical study. Arthroscopy, 12: 309-322, 1996. https://doi.org/10.1016/S0749-8063(96)90063-8
  13. Rowe CR, Zarins B, Ciullo JV: Recurrent anterior dislocation of the shoulder after surgical repair. Apparent causes of failure and treatment. J Bone Joint Surg Am, 66: 159-168, 1984.
  14. Lee SJ, Park JY, Keum JS, Meng Ye: Glenoid lesion in Traumatic Anterior Instability of Shoulder. J Korean Shoulder Elbow Soc, 10: 23-26, 2007. https://doi.org/10.5397/CiSE.2007.10.1.023
  15. Sugaya H, Moriishi J, Dohi M, Kon Y, Tsuchiya A: Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg Am, 85: 878- 884, 2003.
  16. Sugaya H, Moriishi J, Kanisawa I, Tsuchiya A: Arthroscopic osseous Bankart repair for chronic recurrent traumatic anterior glenohumeral instability. Surgical technique. J Bone Joint Surg Am, 88: 159-169, 2006. https://doi.org/10.2106/JBJS.F.00319
  17. Wolf EM: Arthroscopic capsulolabral repair using suture anchor. Orthop Clin North Am, 24: 59-69, 1993.
  18. Wolf EM, Wilk RM: Arthroscopic Bankart repair using suture anchors. Op Tech Orthop, 1: 184, 1991. https://doi.org/10.1016/S1048-6666(05)80030-8
  19. Yoneda M: New concept of arthroscopic Bankart repair : Double anchor footprint fixation (DAFF) technique. J Bone Joint Surg Am, 24: 1305-1316, 2005.