Demirhan Mehmet, Esenyel Cem Zeki
Istanbul Universitesi Istanbul Tip Fakültesi Ortopedi ve Travmatoloji Anabilim Dali, Capa.
Acta Orthop Traumatol Turc. 2005;39 Suppl 1:57-74.
The main pathology in traumatic anterior instability of the shoulder is a Bankart lesion and capsuloligamentous laxity. Success in the treatment of glenohumeral instability mainly relies on an anatomical attachment of the fibrocartilaginous labrum and restoration of tension of the capsuloligamentous structures. Suture anchors are preferred for the fixation of soft tissues. Excessive capsular laxity can be treated by capsular plication or thermal capsulorrhaphy. Arthroscopy enables examination and repair of the glenohumeral structures, with several advantages over open techniques, including less morbidity and pain, shorter hospitalization, better cosmetic appearance, and a lower complication rate. These advantages have contributed to the growing acceptance of arthroscopic treatment in dealing with traumatic anterior glenohumeral instability. Moreover, its success rate has increased thanks to advances in technology and surgical techniques. Yet, appropriate selection of patients, the quality of capsulolabral structures, coexisting pathologies, and experience on the part of the surgeon are important factors in the success of arthroscopic treatment of anterior shoulder instability. This paper discusses the rationale for a treatment algorithm for arthroscopic applications together with recommendations about anterior instability of the shoulder.
创伤性肩关节前向不稳的主要病理改变是Bankart损伤和关节囊韧带松弛。盂肱关节不稳的治疗成功主要依赖于纤维软骨盂唇的解剖学附着以及关节囊韧带结构张力的恢复。软组织固定首选缝合锚钉。关节囊过度松弛可通过关节囊折叠或热关节囊缝合术治疗。关节镜检查能够对盂肱关节结构进行检查和修复，与开放手术相比具有多项优势，包括发病率和疼痛更低、住院时间更短、外观更好以及并发症发生率更低。这些优势促使关节镜治疗在处理创伤性盂肱关节前向不稳方面越来越被接受。此外，由于技术和手术技巧的进步，其成功率也有所提高。然而，患者的恰当选择、关节盂唇结构的质量、并存的病理情况以及外科医生的经验是关节镜治疗肩关节前向不稳成功的重要因素。本文讨论了关节镜应用治疗方案的理论依据以及关于肩关节前向不稳的建议。
