Pagnani Michael J, Dome David C
Tennesse Orthopaedic Alliance, Nashville, TN 37203, USA.
J Bone Joint Surg Am. 2002 May;84(5):711-5. doi: 10.2106/00004623-200205000-00002.
American football players have been reported to be at high risk for postoperative instability after arthroscopic stabilization of anterior shoulder instability. While some authors have recommended open methods of stabilization in athletes who play contact sports, there are few data in the literature showing more favorable results with use of an open technique. We reviewed the results of an open technique of anterior shoulder stabilization in fifty-eight American football players after a minimum of two years of follow-up.
Fifty-eight American football players underwent open stabilization with use of a standardized technique for the treatment of recurrent anterior shoulder instability. Forty-seven patients had recurrent dislocations, and the remaining eleven had recurrent subluxations. The average age of the patients was 18.2 years, and the average duration of follow-up was thirty-seven months. Patients were evaluated according to the shoulder scoring system of the American Shoulder and Elbow Surgeons and with use of the shoulder instability score described by Rowe and Zarins.
There were no postoperative dislocations. Postoperative subluxation occurred in two patients, neither of whom had had a dislocation prior to the operation. Forward flexion and external rotation returned to within 5 of those of the contralateral shoulder in forty-nine patients. The average score according to the system of the American Shoulder and Elbow Surgeons was 97.0 points, and the average Rowe and Zarins score was 93.6 points. Fifty-five patients had a good or excellent result, and fifty-two of the fifty-eight returned to playing football for at least one year. One patient was forced to stop playing because of recurrent instability.
Open stabilization is a predictable method of restoring shoulder stability in American football players while maintaining a range of motion approximating that found after arthroscopic stabilization. Postoperative stability appears to be superior to that reported after arthroscopic techniques in this population of patients.
据报道，美式橄榄球运动员在肩关节前不稳定关节镜稳定术后存在较高的术后不稳定风险。虽然一些作者建议对从事接触性运动的运动员采用开放稳定术，但文献中几乎没有数据表明使用开放技术能取得更理想的效果。我们回顾了58名美式橄榄球运动员采用开放技术进行肩关节前稳定术至少两年后的随访结果。
58名美式橄榄球运动员采用标准化技术进行开放稳定术，以治疗复发性肩关节前不稳定。47例患者有复发性脱位，其余11例有复发性半脱位。患者的平均年龄为18.2岁，平均随访时间为37个月。根据美国肩肘外科医生协会的肩关节评分系统以及Rowe和Zarins描述的肩关节不稳定评分对患者进行评估。
术后无脱位发生。两名患者出现术后半脱位，他们在手术前均未发生过脱位。49例患者的前屈和外旋恢复到对侧肩关节的5°范围内。根据美国肩肘外科医生协会系统的平均评分为97.0分，Rowe和Zarins的平均评分为93.6分。55例患者的结果为良好或优秀，58例中有52例恢复踢足球至少一年。1例患者因复发性不稳定被迫停止踢球。
开放稳定术是恢复美式橄榄球运动员肩关节稳定性的一种可预测方法，同时能保持接近关节镜稳定术后的活动范围。在这群患者中，术后稳定性似乎优于关节镜技术报道的结果。
