Araghi Arash, Prasarn Mark, St Clair Selvon, Zuckerman Joseph D
NYU-Hospital for Joint Diseases, Department of Orthopaedic Surgery, 550 First Avenue, New York, New York 10016, USA.
Bull Hosp Jt Dis. 2005;62(3-4):99-101.
Recurrent instability in patients over forty years of age is felt to occur primarily as a result of an associated rotator cuff tear. This is often referred to as the "posterior mechanism." We reviewed our patients over the age of forty who underwent an anterior shoulder repair to identify the incidence of capsulolabral detachments and the role of an "anterior mechanism" in this patient population. A retrospective review of all patients from 1985 to 2000 was performed to identify patients who had surgery for recurrent instability that began after forty years of age. Of the 265 patients records reviewed, 11 patients were identified who fulfilled the inclusion criteria. Of the 11 patients identified, 9 patients underwent anterior capsulolabral reconstruction for recurrent instability; the remaining two patients underwent repair of large rotator cuff tears. All 9 patients had a capsulolabral detachment, 4 had a rotator interval defect, 2 had anterior and inferior capsular redundancy, 1 had a small rotator cuff tear and 1 had an anterior capsular avulsion from the humeral head. At minimum follow-up of 32 months none of the patients reported episodes of instability. The reported incidence of rotator cuff tears in patients over the age of forty following an initial traumatic anterior glenohumeral dislocation ranges from 35% to 100%. When recurrent instability occurs, it is postulated to occur via a "posterior mechanism" (i.e., secondary to a significant full-thickness rotator cuff tear). However, all of our patients had an anterior capsulolabral detachment as the "common lesion" associated with recurrent instability. Although small, this series emphasizes the role of the "anterior mechanism" in patients who develop recurrent instability after the age of forty. A high rate of success was achieved by addressing the pathoanatomic changes identified.
四十岁以上患者复发性肩关节不稳定主要被认为是由相关的肩袖撕裂所致。这通常被称为“后方机制”。我们回顾了四十岁以上接受前肩修复术的患者，以确定关节囊盂唇分离的发生率以及“前方机制”在该患者群体中的作用。对1985年至2000年的所有患者进行回顾性研究，以确定四十岁后因复发性不稳定而接受手术的患者。在审查的265例患者记录中，确定有11例符合纳入标准。在这11例患者中，9例因复发性不稳定接受了前关节囊盂唇重建术；其余2例患者接受了大型肩袖撕裂修复术。所有9例患者均有关节囊盂唇分离，4例有旋转间隙缺损，2例有前下方关节囊冗余，1例有小的肩袖撕裂，1例有前关节囊从肱骨头撕脱。在至少32个月的随访中，所有患者均未报告不稳定发作。据报道，初次创伤性前盂肱关节脱位后四十岁以上患者肩袖撕裂的发生率为35%至100%。当发生复发性不稳定时，推测是通过“后方机制”（即继发于明显的全层肩袖撕裂）发生的。然而，我们所有患者均存在前关节囊盂唇分离，这是与复发性不稳定相关的“常见病变”。尽管样本量小，但该系列研究强调了“前方机制”在四十岁后出现复发性不稳定患者中的作用。通过处理所发现的病理解剖变化，取得了较高的成功率。
