以改良之Bankart術式治療習慣性肩關節脫臼

Modified Bankart Procedure for Recurrent Shoulder Dislocation

習慣性肩關節脫臼是年輕人常見的肩部疾病。從1993年4月到1996年3月這三年之間，有10位病人（10個肩關節）因為習慣性肩關節脫臼而在台大醫院接受改良之Bankart術式治療。造成第一次脫臼的原因，有8位是運動傷害，另2位則為機車車禍造成，每—位病人在手術前都至少曾有5次的脫臼（其中有5位病人其脫臼在20次以上）。手術中，我們在每位病人身上皆可發現到Bankart病灶及關節囊鬆弛。我們的方法是利用軟組織固定錨(TAG suture anchor)(Acufex Microsurgical Inc., Mansfield, MA)及T型關節囊整形縫合術(T. plasty capsulorrhaphy)來改進Bankart術式，在術後每位病人都接受相同的復健療程，並定期門診追蹤。他們最近一次追蹤和開刀日期的間隔，分佈在12個月到30個月之間，平均為16.7個月。每位病人都可以平順地回復術前的活動能力，有一位病人在術後5個月時因劇烈運動而有半脫位的感覺，但不是真正的脫臼，另一位病人則抱怨在舉重物時會覺得肩膀不舒服，所有病人對肩關節不穩定的理學檢查結果皆為陰性。若以Rowe等人所設計的肩關節評量表來計算病人分數，他們平均在術前僅得28.5分，而術後追蹤進步到95分，要強調的是沒有任何一位病人產生和此次手術有關的合併症，和從前用傳統方式手術比較起來，結果一樣好，但手術技巧更為簡單，病人傷口較小，手術時間較短，因此我們樂於去推薦此一手術方式來治療年輕患者的習慣性肩關節脫臼。

Instability is a common disorder affecting the shoulder in active young individuals. Between April 1993 and March 1996, 10 patients (10 shoulders) underwent a modified Bankart procedure for recurrent anterior shoulder dislocation, at National Taiwan University Hospital. The causes of initial dislocation were sports-related injuries in eight patients and motorcycle accidents in two patients. All patients had at least five recurrences (more than 20 times in five patients) of shoulder dislocation before operation. The operative findings showed positive Bankart lesion and redundant joint capsule in all subjects. A modified Bankart reconstruction with tissue suture anchor (TAG) and T-plasty capsulorrhaphy were performed in each case, followed by a rehabilitation program at outpatient clinics. Patients were followed up for a period of 12 to 30 months, with an average follow-up period of 16.7 months. All patients returned to preoperative activities smoothly No complications related to the surgery occurred. Only one patient still suffers from occasional shoulder pain while lifting objects. Another patient had one episode of threatened shoulder dislocation at 5 months after surgery, during vigorous exercise. No instability could be detected by manual test at the latest follow up. We used the rating score devised by Rowe et al to determine the preoperative and postoperative score. The average scores were 28.5 preoperatively and 95 postoperatively. The technique is a simple and effective procedure for the surgical treatment of recurrent shoulder dislocation in young and athletic patients.