Kim Seung-Ho, Ha Kwon-Ick, Park Jong-Hyuk, Kim Young-Min, Lee Yong-Seuk, Lee Jong-Youl, Yoo Jae-Chul
Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
J Bone Joint Surg Am. 2003 Aug;85(8):1479-87. doi: 10.2106/00004623-200308000-00008.
The purpose of this study was to evaluate the results of arthroscopic treatment of traumatic unidirectional recurrent posterior subluxation of the shoulder.
We treated twenty-seven patients who had traumatic unidirectional recurrent posterior subluxation of the shoulder with arthroscopic labral repair and posterior capsular shift, and we evaluated them at a mean of thirty-nine months postoperatively. Patients who had posteroinferior instability, multidirectional instability, or an atraumatic onset or who were undergoing revision were excluded. There were twenty-five male and two female patients with a mean age of twenty-one years (range, fourteen to thirty-three years). All patients were involved in sports activity, and all had had a substantial injury prior to the onset of the instability. Results were assessed on the basis of stability, motion, and UCLA (University of California at Los Angeles), ASES (American Shoulder and Elbow Surgeons), and Rowe scores. Pain and function were also evaluated with visual analog scales.
All patients had one or more lesions in the posteroinferior aspect of the labrum and capsule. The most common finding was incomplete stripping of the posteroinferior aspect of the labrum (eighteen patients). At the arthroscopy, the posteroinferior aspect of the capsule appeared to be stretched in twenty-two patients. At the time of follow-up, all patients had improved shoulder function and scores (p < 0.01). All patients also had a stable shoulder according to subjective and objective measurements, except for one patient who had recurrent subluxation. Except for that patient, all patients were able to return to their prior sports activity with little or no limitation. Shoulder function was graded as >90% of the preinjury level in twenty-four patients. There were twenty-one excellent UCLA scores, five good scores, and one fair score. The average pain score improved from 4.5 points preoperatively to 0.2 point at the time of follow-up (p < 0.0001). The mean loss of internal rotation was one vertebral level. There were no operative complications.
Arthroscopic posterior labral repair and capsular shift to treat traumatic unidirectional recurrent posterior subluxation is a reliable procedure with respect to providing stability, pain relief, and functional restoration.
本研究的目的是评估关节镜治疗创伤性单向复发性肩关节后脱位的结果。
我们对27例创伤性单向复发性肩关节后脱位患者进行了关节镜下盂唇修复和后关节囊移位治疗，并在术后平均39个月对他们进行了评估。排除存在后下不稳定、多向不稳定、非创伤性发病或正在接受翻修手术的患者。共有25例男性和2例女性患者，平均年龄21岁（范围14至33岁）。所有患者均参与体育活动，且在不稳定发作前均遭受过严重损伤。根据稳定性、活动度以及加州大学洛杉矶分校（UCLA）、美国肩肘外科医师学会（ASES）和Rowe评分对结果进行评估。还使用视觉模拟量表对疼痛和功能进行了评估。
所有患者的盂唇和关节囊后下方面均有一处或多处损伤。最常见的发现是盂唇后下方面不完全剥离（18例患者）。在关节镜检查时，22例患者的关节囊后下方面似乎有拉伸。在随访时，所有患者的肩部功能和评分均有所改善（p < 0.01）。根据主观和客观测量，除1例患者出现复发性脱位外，所有患者的肩部均稳定。除该患者外，所有患者均能几乎不受限制或仅受轻微限制地恢复到先前的体育活动。24例患者的肩部功能分级为损伤前水平的>90%。UCLA评分21例为优，5例为良，1例为可。平均疼痛评分从术前的4.5分改善至随访时的0.2分（p < 0.0001）。内旋平均丧失一个椎体节段。无手术并发症。
关节镜下盂唇后修复和关节囊移位治疗创伤性单向复发性肩关节后脱位在提供稳定性、缓解疼痛和功能恢复方面是一种可靠的手术方法。
