Provencher Matthew T, Bell S Josh, Menzel Kyle A, Mologne Timothy S
Division of Orthopaedic Shoulder & Sports Medicine, Naval Medical Center San Diego, Department of Orthopaedic Surgery, San Diego, CA 92134-1112, USA.
Am J Sports Med. 2005 Oct;33(10):1463-71. doi: 10.1177/0363546505278301. Epub 2005 Aug 10.
Posterior shoulder instability is a relatively rare condition and a surgical challenge. Arthroscopic techniques have allowed for a potential improvement as well as diagnosis and management of this condition.
To evaluate the outcomes of arthroscopic posterior shoulder stabilization and to evaluate preoperative and intraoperative variables as predictors of success.
Case series; Level of evidence, 4.
Thirty-three consecutive patients with a mean age of 25 years (range, 19-34 years) who underwent posterior arthroscopic shoulder stabilization with suture anchors (mean, 3 anchors) or suture capsulolabral plication (mean, 5.3 stitches) or both were reviewed at a mean follow-up of 39.1 months (range, 22-60 months). Shoulder outcomes rating scores were determined using the American Shoulder and Elbow Surgeons Rating Scale, the Western Ontario Shoulder Instability Index, the Subjective Patient Shoulder Evaluation, and the Single Assessment Numeric Evaluation.
There were 7 failures: 4 for recurrent instability and 3 for symptoms of pain. Overall, outcomes scores demonstrated mean values of the American Shoulder and Elbow Surgeons Rating Scale of 94.6, Subjective Patient Shoulder Evaluation of 20.0, Western Ontario Shoulder Instability Index of 389.4 (81.5% of normal), and Single Assessment Numeric Evaluation of 87.5. Patients with voluntary instability demonstrated worse outcomes (P = .025), and those with prior surgery of the shoulder also did worse (P = .02).
Arthroscopic treatment of posterior shoulder instability is an effective means to improve symptoms associated with recurrent posterior subluxation of the shoulder. It can provide predictable success in the setting of unidirectional, nonvoluntary posterior instability without prior surgery.
肩后部不稳定是一种相对罕见的病症，也是一项手术挑战。关节镜技术为该病症的诊断、治疗以及潜在改善提供了可能。
评估关节镜下肩后部稳定术的疗效，并评估术前和术中变量作为成功预测指标的情况。
病例系列研究；证据等级，4级。
对33例连续患者进行回顾性研究，这些患者平均年龄25岁（范围19 - 34岁），接受了关节镜下肩后部稳定术，采用缝线锚钉（平均3个锚钉）或关节囊盂唇折叠缝合（平均5.3针）或两者联合使用，平均随访39.1个月（范围22 - 60个月）。使用美国肩肘外科医师评分量表、西安大略肩不稳定指数、患者主观肩部评估以及单项评估数值评估来确定肩部疗效评分。
有7例治疗失败：4例为复发性不稳定，3例为疼痛症状。总体而言，疗效评分显示美国肩肘外科医师评分量表的平均值为94.6，患者主观肩部评估为20.0，西安大略肩不稳定指数为389.4（为正常的81.5%），单项评估数值评估为87.5。有主动性不稳定的患者疗效较差（P = 0.025），既往有肩部手术史的患者疗效也较差（P = 0.02）。
关节镜治疗肩后部不稳定是改善与肩部复发性后脱位相关症状的有效方法。在无既往手术史的单向、非主动性后不稳定情况下，该方法可取得可预测的成功效果。
