Wong Kirk L, Getz Charles L, Yeh George L, Ramsey Matthew, Iannotti Joseph P, Williams Gerald R
Department of Orthopaedic Surgery, The Hospitals of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Arthroscopy. 2005 Aug;21(8):985-91. doi: 10.1016/j.arthro.2005.05.003.
The purpose of this study was to review the results of a relatively homogenous group of patients with glenohumeral subluxation without labral pathology who were treated with an electrothermal capsulorrhaphy procedure.
Case series without controls.
From 1997 to 1998, 42 patients underwent electrothermal capsulorrhaphy using a monopolar radiofrequency probe (Oratec Interventions, Menlo Park, CA). Patients with prior capsular repairs, labral pathology that required repair, or capsular avulsion injuries were excluded from the study. Thirty-one patients met the inclusion criteria. Patients had a minimum of 2 years of follow-up (mean, 25 months), and a mean age of 25 years (range, 16 to 38 years). All of the patients had previously failed conservative treatment. There were 25 patients with unidirectional anterior instability, 2 patients with unidirectional inferior instability, 1 patient with unidirectional posterior instability, and 3 patients with multidirectional instability. The patients were assessed using a modified American Shoulder and Elbow Surgeons (ASES) score that examined pain (30 points), function (60 points), and patient satisfaction (10 points). In addition, subjective stability was assessed using a 10-point scale.
The average modified ASES score increased to 88 points from 56 preoperatively (P < .01). The average subjective stability scale increased to 8.5 from 4.4 preoperatively (P < .01). Nineteen patients (61%) had an excellent result, 4 (13%) had a good result, 5 (16%) had a fair result, and 3 (10%) had a poor result; 22 of 26 patients who participated in sports were able to return to their preinjury level of play. The subset of patients with isolated anterior instability had results similar to the overall group. There were no instances of axillary neuritis or other neurologic injury.
In carefully selected patients with shoulder instability, including unidirectional anterior instability without associated labral pathology, electrothermal capsulorrhaphy was effective and had few complications.
Level IV, case series without controls.
本研究旨在回顾一组相对同质的、无盂唇病变的肩肱关节半脱位患者接受电热关节囊紧缩术的治疗结果。
无对照的病例系列研究。
1997年至1998年，42例患者使用单极射频探头（Oratec Interventions，加利福尼亚州门洛帕克）接受电热关节囊紧缩术。既往有囊修复术、需要修复的盂唇病变或囊撕脱伤的患者被排除在研究之外。31例患者符合纳入标准。患者至少随访2年（平均25个月），平均年龄25岁（范围16至38岁）。所有患者此前保守治疗均失败。其中25例为单向性前向不稳定，2例为单向性下向不稳定，1例为单向性后向不稳定，3例为多向性不稳定。采用改良的美国肩肘外科医生（ASES）评分对患者进行评估，该评分包括疼痛（30分）、功能（60分）和患者满意度（10分）。此外，采用10分制评估主观稳定性。
改良ASES评分平均从术前的56分提高到88分（P <.01）。主观稳定性评分平均从术前的4.4分提高到8.5分（P <.01）。19例（61%）患者效果极佳，4例（13%）效果良好，5例（16%）效果一般，3例（10%）效果较差；26例参加运动的患者中有22例能够恢复到受伤前的运动水平。单纯前向不稳定患者亚组的结果与总体组相似。未发生腋神经炎或其他神经损伤病例。
在经过精心挑选的肩部不稳定患者中，包括无相关盂唇病变的单向性前向不稳定患者，电热关节囊紧缩术有效且并发症少。
IV级，无对照的病例系列研究。
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