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基于单纯关节囊和韧带冗余的多向不稳定运动员的关节囊下移位手术

Inferior capsular shift procedure in athletes with multidirectional instability based on isolated capsular and ligamentous redundancy.

作者信息

Bak K, Spring B J, Henderson J P

机构信息

Orthopedic Research Department, Mercy Private Hospital, Melbourne, Australia.

出版信息

Am J Sports Med. 2000 Jul-Aug;28(4):466-71. doi: 10.1177/03635465000280040501.

Abstract

Twenty-five athletes (26 shoulders) who underwent an inferior capsular shift procedure for multidirectional glenohumeral instability based on isolated capsular and ligamentous redundancy were evaluated at a median of 54 months (range, 25 to 113) after the operation. Twenty-one athletes (84%) returned to their preinjury activity level at a median of 5 months after surgery. Of 21 athletes involved in sports using overhead motions, 16 (76%) returned to their previous sport after the operation, and 12 (57%) were still active in this sport at the preinjury level at follow-up. According to the Rowe score, 23 shoulders (88%) were excellent or good. The University of California at Los Angeles score for 24 shoulders (92%) was excellent or good. The operations on two shoulders (8%) failed. One patient had a spontaneous redislocation, and one had recurrent subluxations. Nine contralateral shoulders had a history of significant instability; four of these had undergone Bankart repair. We concluded that athletes who have multidirectional instability based on isolated capsular and ligamentous redundancy can be successfully treated by an inferior capsular shift preserving the subscapularis tendon insertion. We found a high rate of return to demanding upper extremity sports in our patients, range of motion was restored in the majority of shoulders, and the failure rate after a median of 54 months was acceptable.

摘要

25名运动员(26个肩关节)因单纯关节囊和韧带松弛导致多向性肩肱关节不稳而接受了关节囊下移位手术,术后中位随访时间为54个月(范围25至113个月)。21名运动员(84%)在术后中位5个月时恢复到伤前的活动水平。在21名从事过头顶运动项目的运动员中,16名(76%)术后重返原运动项目,12名(57%)在随访时仍能以伤前水平参与该运动项目。根据Rowe评分,23个肩关节(88%)为优或良。24个肩关节(92%)的加州大学洛杉矶分校(UCLA)评分为优或良。2个肩关节(8%)手术失败。1例患者出现自发性再脱位,1例出现复发性半脱位。9个对侧肩关节有明显不稳病史;其中4个接受过Bankart修复术。我们得出结论,因单纯关节囊和韧带松弛导致多向性不稳的运动员,通过保留肩胛下肌腱止点的关节囊下移位手术可获得成功治疗。我们发现患者重返高要求上肢运动项目的比例很高,大多数肩关节的活动范围得以恢复,中位54个月后的失败率可以接受。

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