Robinson C Michael, Howes Jonathan, Murdoch Helen, Will Elizabeth, Graham Catriona
The New Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh EH16 4SU, Scotland.
J Bone Joint Surg Am. 2006 Nov;88(11):2326-36. doi: 10.2106/JBJS.E.01327.
The prevalence and risk factors for recurrent instability and functional impairment following a primary glenohumeral dislocation remain poorly defined in younger patients. We performed a prospective cohort study to evaluate these outcomes. We also aimed to produce guidelines for the design of future clinical trials, assessing the efficacy of interventions designed to improve the outcome after a primary dislocation.
We performed a prospective cohort study of 252 patients ranging from fifteen to thirty-five years old who sustained an anterior glenohumeral dislocation and were treated with sling immobilization, followed by a physical therapy program. Patients received regular clinical follow-up to assess whether recurrent instability had developed. Functional assessments were made and were compared for two subgroups: those who had not had instability develop and those who had received operative stabilization to treat recurrent instability.
On survival analysis, instability developed in 55.7% of the shoulders within the first two years after the primary dislocation and increased to 66.8% by the fifth year. The younger male patients were most at risk of instability, and 86.7% of all of the patients known to have recurrent instability had this complication develop within the first two years. A small but measurable degree of functional impairment was present at two years after the initial dislocation in most patients. Sample-size calculations revealed that a relatively small number of patients with a primary dislocation would be required in future clinical trials examining the effects of interventions designed to reduce the prevalence of recurrent instability and improve the functional outcome.
Recurrent instability and deficits of shoulder function are common after primary nonoperative treatment of an anterior shoulder dislocation. There is substantial variation in the risk of instability, with younger males having the highest risk and females having a much lower risk. Future clinical trials to evaluate primary interventions should evaluate the prevalence of recurrent instability and functional deficits, with use of an assessment tool specifically for shoulder instability, during the first two years after the initial dislocation.
在年轻患者中，原发性盂肱关节脱位后复发性不稳定和功能障碍的患病率及危险因素仍未明确。我们进行了一项前瞻性队列研究以评估这些结果。我们还旨在制定未来临床试验设计指南，评估旨在改善原发性脱位后结局的干预措施的疗效。
我们对252例年龄在15至35岁之间的原发性前盂肱关节脱位患者进行了前瞻性队列研究，这些患者接受了吊带固定治疗，随后进行了物理治疗计划。患者接受定期临床随访以评估是否发生复发性不稳定。对两个亚组进行了功能评估并比较：未发生不稳定的患者和接受手术稳定治疗复发性不稳定的患者。
生存分析显示，在原发性脱位后的头两年内，55.7%的肩关节出现不稳定，到第五年增加到66.8%。年轻男性患者发生不稳定的风险最高，已知有复发性不稳定的所有患者中，86.7%在头两年内出现了这种并发症。大多数患者在初次脱位两年后存在轻微但可测量的功能障碍。样本量计算表明，在未来研究旨在降低复发性不稳定患病率并改善功能结局的干预措施效果的临床试验中，所需的原发性脱位患者数量相对较少。
原发性前肩关节脱位非手术治疗后，复发性不稳定和肩部功能缺陷很常见。不稳定风险存在很大差异，年轻男性风险最高，女性风险则低得多。未来评估原发性干预措施的临床试验应在初次脱位后的头两年内，使用专门针对肩部不稳定的评估工具，评估复发性不稳定和功能缺陷的患病率。
