Kirkley A, Griffin S, Richards C, Miniaci A, Mohtadi N
Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Canada.
Arthroscopy. 1999 Jul-Aug;15(5):507-14. doi: 10.1053/ar.1999.v15.015050.
Our purpose was to compare the effectiveness of traditional treatment with immediate arthroscopic stabilization in young patients who have sustained a first traumatic anterior dislocation of the shoulder. Forty skeletally mature patients younger than 30 years of age were randomly allocated to immobilization for 3 weeks followed by rehabilitation (group T) or arthroscopic stabilization (within 4 weeks of injury) followed by an identical immobilization and rehabilitation protocol (group S). A blinded research assistant performed all follow-up evaluations. The dominant arm was involved in 35% of subjects. The injury occurred in a sporting event in 70% of subjects. At 24 months, there was a statistically significant difference in the rate of redislocation (T = 47%, S = 15.9%, P = .03). An intention-to-treat analysis comparing disease-specific quality of life using the validated Western Ontario Shoulder Instability (WOSI) index showed statistically significantly better results in the surgically treated group at the 33 months (T = 633.93 v S = 287.1, P = .03) and no significant difference in range of motion. At an average 32 months follow-up, a significant reduction in redislocation and improvement in disease-specific quality of life is afforded by early arthroscopic stabilization in patients less than 30 year of age with a first, traumatic, anterior dislocation of the shoulder.
我们的目的是比较传统治疗与即刻关节镜下稳定术在首次创伤性肩关节前脱位的年轻患者中的有效性。40名年龄小于30岁的骨骼成熟患者被随机分为两组，一组进行3周固定，随后进行康复治疗（T组）；另一组在损伤后4周内接受关节镜下稳定术，随后进行相同的固定和康复方案（S组）。一名不知情的研究助理进行了所有的随访评估。35%的受试者受累侧为优势臂。70%的受试者损伤发生在体育赛事中。在24个月时，再脱位率存在统计学显著差异（T组=47%，S组=15.9%，P = .03）。使用经过验证的西安大略肩关节不稳定（WOSI）指数进行意向性分析，比较疾病特异性生活质量，结果显示在33个月时手术治疗组的结果在统计学上显著更好（T组=633.93，S组=287.1，P = .03），且两组在活动范围上无显著差异。在平均32个月的随访中，对于年龄小于30岁的首次创伤性肩关节前脱位患者，早期关节镜下稳定术可显著降低再脱位率并改善疾病特异性生活质量。
