Hansen Brent P, Beck Charles L, Beck Elizabeth P, Townsley Robert W
Advanced Joint Care and Orthopedic Sports Medicine, 4344 West Bell Road, Suite 102, Glendale, AZ 85308, USA.
Am J Sports Med. 2007 Oct;35(10):1628-34. doi: 10.1177/0363546507304136. Epub 2007 Jul 3.
Recent reports have noted the appearance of postarthroscopic glenohumeral chondrolysis. Although this devastating process has been identified, no cause has been directly identified.
A cause of postarthroscopic glenohumeral chondrolysis will be associated with a specific factor (ie, implanted device, surgical technique, etc), and this factor can be identified by a review and comparison of cases seen in the senior author's office.
Case series; Level of evidence, 4.
Analyze possible etiologic factors with imaging studies, demographics, history, and physical examinations of 10 patients (12 shoulders) with postarthroscopic glenohumeral chondrolysis, and then compare perisurgical information with a focused chart review and comparison with the rest of the 177 arthroscopic shoulder surgeries in the same period of time.
There were 12 cases of postarthroscopic glenohumeral chondrolysis (all were the senior author's patients). Four common factors were identified, and only high-flow intra-articular pain pump catheters filled with bupivacaine and epinephrine were a new addition to years of shoulder surgery by the senior author; 177 shoulders underwent arthroscopy in the identified time frame, and only 19 shoulders, of 30 with capsular procedures, had intra-articular pain pump catheters filled with bupivacaine and epinephrine. Of these, 12 have been identified with chondrolysis.
Use of intra-articular pain pump catheters eluting bupivacaine with epinephrine appear highly associated with postarthroscopic glenohumeral chondrolysis.
Intra-articular pain pump catheters, especially those eluting bupivacaine with epinephrine, should be avoided until further investigation.
近期报告指出关节镜检查后出现了盂肱关节软骨溶解。尽管已确认这一破坏性过程，但尚未直接确定其病因。
关节镜检查后盂肱关节软骨溶解的病因将与特定因素（如植入装置、手术技术等）相关，并且通过对资深作者诊所中所见病例的回顾和比较可以确定该因素。
病例系列；证据等级，4级。
对10例（12个肩关节）关节镜检查后盂肱关节软骨溶解患者进行影像学研究、人口统计学、病史和体格检查，分析可能的病因因素，然后通过重点图表回顾将围手术期信息与同期177例肩关节镜手术的其他病例进行比较。
有12例关节镜检查后盂肱关节软骨溶解病例（均为资深作者的患者）。确定了四个共同因素，而仅填充布比卡因和肾上腺素的高流量关节内疼痛泵导管是资深作者多年肩部手术中的新增因素；在确定的时间范围内有177个肩关节接受了关节镜检查，在30例进行关节囊手术的患者中，只有19个肩关节使用了填充布比卡因和肾上腺素的关节内疼痛泵导管。其中，12例已被确诊为软骨溶解。
使用洗脱布比卡因和肾上腺素的关节内疼痛泵导管似乎与关节镜检查后盂肱关节软骨溶解高度相关。
在进一步研究之前，应避免使用关节内疼痛泵导管，尤其是那些洗脱布比卡因和肾上腺素的导管。
