Matsoukis J, Tabib W, Guiffault P, Mandelbaum A, Walch Gilles, Némoz Chantal, Edwards T Bradley
Department of Orthopaedic Surgery, Clinique Sainte Anne Lumière, Lyon, France.
J Bone Joint Surg Am. 2003 Aug;85(8):1417-24. doi: 10.2106/00004623-200308000-00001.
Prior reports of shoulder arthroplasty performed for dislocation-induced arthropathy have included only patients who had had a prior stabilizing procedure. The purpose of this study was to report the results of shoulder arthroplasty in all patients with a prior anterior shoulder dislocation, including both those previously treated operatively and those previously treated nonoperatively.
Fifty-five shoulders undergoing arthroplasty for arthritis following a prior anterior shoulder dislocation were evaluated. Twenty-seven of the shoulders had undergone a prior anterior stabilization procedure. The measures used to evaluate the shoulders included the Constant score, adjusted Constant score, active mobility, subjective satisfaction, radiographic result, and complications.
The shoulders were evaluated at a mean of 45.0 months. The Constant score improved from a mean of 30.8 points preoperatively to a mean of 65.8 points at the time of follow-up. The adjusted Constant score improved from a mean of 38.2% to a mean of 79.8%. Active forward flexion improved from a mean of 82.1 degrees to a mean of 138.9 degrees. Active external rotation improved from a mean of 4.0 degrees to a mean of 38.6 degrees. Fifty patients rated the result as good or excellent. Negative prognosticators included an older age at the time of the initial dislocation and a rotator cuff tear. No significant differences in demographic factors, pre-arthroplasty function, post-arthroplasty function, pre-arthroplasty radiographic findings, post-arthroplasty radiographic findings, complication rate, or reoperation rate were noted between the patients treated with a prior operation for the anterior instability and those treated nonoperatively.
This investigation documented the good results obtainable with shoulder arthroplasty for the treatment of arthritis following anterior shoulder instability. In addition, our findings suggest that capsulorrhaphy-induced arthropathy may be indistinguishable from arthritis following nonoperatively treated anterior shoulder instability.
先前关于因脱位性关节病而行肩关节置换术的报道仅纳入了曾接受过稳定手术的患者。本研究的目的是报告所有既往有肩关节前脱位患者的肩关节置换术结果，包括既往接受手术治疗和非手术治疗的患者。
对55例既往有肩关节前脱位后因关节炎而行关节置换术的肩关节进行评估。其中27例肩关节曾接受过前路稳定手术。用于评估肩关节的指标包括Constant评分、调整后的Constant评分、主动活动度、主观满意度、影像学结果及并发症。
肩关节平均在45.0个月时进行评估。Constant评分从术前的平均30.8分提高到随访时的平均65.8分。调整后的Constant评分从平均38.2%提高到平均79.8%。主动前屈从平均82.1度提高到平均138.9度。主动外旋从平均4.0度提高到平均38.6度。50例患者将结果评为良好或优秀。不良预后因素包括初次脱位时年龄较大和肩袖撕裂。在既往因前方不稳定接受手术治疗的患者与非手术治疗的患者之间，在人口统计学因素、置换术前功能、置换术后功能、置换术前影像学表现、置换术后影像学表现、并发症发生率或再次手术率方面未发现显著差异。
本研究证明了肩关节置换术治疗肩关节前不稳定后关节炎可取得良好效果。此外，我们的研究结果表明，关节囊缝合术引起的关节病可能与非手术治疗的肩关节前不稳定后的关节炎难以区分。
