外傷性肩関節前方不安定症に対する鏡視下 Bankart 法の合併症とその対策

抄録

The purpose of this study was to evaluate the complications of arthroscopic Bankart repair using absorbable suture anchors, in traumatic anterior instability of the shoulder. We retrospectively studied 357 patients (287 males and 70 females) ranging from 15 to 68 years of age (average, 25 years old ). The mean follow-up was 21.7 months (range 12-86 months) after surgery. Medical records were reviewed to identify complications in the studied patients. The patients were divided into three groups, P group performed arthroscopic Bankart repair using Panalok anchors, PLs group performed using Panalok loop anchors with single suture technique, and PLd group performed using Panalok loop anchors with dual sutures technique. We performed arthroscopic Bankart repair using 2 to 4 Panalok or Panalok loop suture anchors (average, 3.4) and 5 to 8 sutures (Ethibond) in the PLd group. We evaluated the rate of complications in arthroscopic surgery and after surgery. Dislocation and pulling out of the anchor was seen in 7 cases, breakage of the anchor was seen in 2 cases. There were 28 cases of accidental removal of the sutures from the anchor and tangling of the sutures, and there were 15 cases of damage of sutures. There were some cases of equipment failures including a synovial rasp, a drill, 5 cases of suture punch, 10 cases of suture grasper, 4 cases of cannula, 2 cases of the tip of VAPR. There was a small number of postoperative complications, a nerve injury, none of DVT, none of infection, none of complex regional pain syndrome (CRPS), none of hemarthrosis. Complications associated with arthroscopic Bankart repair are relatively rare. Almost all of the complications were concerned with the technique and instruments in surgery. It was possible to remove the broken instruments arthroscopically. Though injury of sutures was seen especially in PLd group, we can respond to these troubles by using strong sutures and with improvement of drill guide.