Green A, Norris T R
Department of Orthopaedic Surgery, Brown University, Providence, RI 02906, USA.
J Shoulder Elbow Surg. 2001 Nov-Dec;10(6):539-45. doi: 10.1067/mse.2001.118007.
We retrospectively reviewed 19 patients (19 shoulders) in whom advanced glenohumeral arthritis developed after anterior instability repair. The anterior instability repairs included 4 Bristow, 4 Putti-Platt (2 in combination with other procedures), 4 Magnuson-Stack, 2 Bankart, and 5 other anterior capsulorrhaphies. Seventeen of the shoulders were treated with arthroplasty: 15 with total shoulder replacement and 2 with humeral head replacement, at a mean age of 45 years (range, 32-69 years). Two patients did not have surgical treatment. The mean internal rotation contracture was 58 degrees (15 degrees -125 degrees ). Eleven patients (65%) required subscapularis lengthening and anterior capsular release to correct a severe internal rotation contracture. Three (18%) had glenoid bone grafting, and one had glenoidplasty to correct severe posterior glenoid wear. The results were evaluated after a mean follow-up of 62 months (range, 24-167 months). Arthroplasty reduced the level of pain in 16 cases (94%). Active forward elevation increased 21 degrees to 120 degrees, active external rotation increased 38 degrees to 41 degrees, and passive internal rotation increased a mean of 3 vertebral levels to T12. There was improvement in functional use of the upper extremity in all cases except one. Subjectively, 12 shoulders were rated as much better, 4 as better, and 1 as worse than preoperatively. Three underwent revision arthroplasty procedures. Advanced glenohumeral arthritis is a rarely reported late sequela of anterior instability surgery. It is more common after nonanatomic repairs, presents in patients at younger ages than typical glenohumeral osteoarthritis, and is characterized by severe internal rotation contracture and posterior glenoid wear. Prosthetic arthroplasty, although technically challenging, effectively reduced pain and improved function in our series.
我们回顾性分析了19例（19个肩关节）在前路不稳定修复术后发生晚期盂肱关节炎的患者。前路不稳定修复术包括4例布里斯托（Bristow）手术、4例普蒂-普拉特（Putti-Platt）手术（其中2例与其他手术联合）、4例马格努森-斯塔克（Magnuson-Stack）手术、2例Bankart手术以及5例其他前路关节囊缝合术。17个肩关节接受了关节置换术：15例行全肩关节置换，2例行肱骨头置换，平均年龄45岁（范围32 - 69岁）。2例患者未接受手术治疗。平均内旋挛缩为58度（15度 - 125度）。11例患者（65%）需要延长肩胛下肌并松解前方关节囊以纠正严重的内旋挛缩。3例（18%）进行了盂骨移植，1例进行了盂成形术以纠正严重的后方盂磨损。平均随访62个月（范围24 - 167个月）后评估结果。关节置换术使16例（94%）患者的疼痛程度减轻。主动前屈抬高增加21度至120度，主动外旋增加38度至41度，被动内旋平均增加3个椎体水平至T12。除1例患者外，所有患者上肢的功能使用均有改善。主观上，12个肩关节的评分比术前好得多，4个较好，1个较差。3例患者接受了翻修关节置换手术。晚期盂肱关节炎是前路不稳定手术罕见的晚期后遗症。在非解剖修复术后更常见，比典型的盂肱骨关节炎患者年龄更小，其特征为严重的内旋挛缩和后方盂磨损。在我们的系列研究中，假体关节置换术虽然技术上具有挑战性，但有效地减轻了疼痛并改善了功能。
