Levy Jonathan C, Virani Nazeem A, Frankle Mark A, Cuff Derek, Pupello Derek R, Hamelin Jeff A
Orthopaedic Institute at Holy Cross Hospital, Fort Lauderdale, FL, USA.
J Shoulder Elbow Surg. 2008 May-Jun;17(3):380-8. doi: 10.1016/j.jse.2007.11.004. Epub 2008 Mar 7.
Chondrolysis following shoulder arthroscopy is a devastating complication, often seen in young patients. After nonoperative measures have been exhausted, there are few treatment options available that reliably improve pain and function. The purpose of this study is to examine the intra-operative findings, radiographic features, and clinical outcomes of a series of patients with chondrolysis following arthroscopic surgery managed with a total shoulder arthroplasty. A retrospective review was performed on 11 patients (average age 39) with shoulder chondrolysis following arthroscopy. Attention was focused on review of the index arthroscopy, radiographs, and functional outcome scores prior to total shoulder arthroplasty, as well as intra-operative cultures, histology, radiographs, and functional outcomes from most recent follow-up. All patients were treated with total shoulder arthroplasty at an average of 26 months after the index arthroscopy. Preoperative and postoperative radiographs were reviewed, and outcomes were compared using validated measurements. Statistically significant improvements in shoulder abduction (89 degrees -123 degrees , P = .027), external rotation (26 degrees -48 degrees , P = .037), total ASES scores (30-77.5, P = .0039), and SST scores (3-8, P = .0078) were noted. Ten patients subjectively rated their outcomes as good or excellent, with 1 as satisfactory. Chondrolysis after shoulder arthroscopy has a rapid clinical progression and is likely multifactorial in etiology. Early results of total shoulder arthroplasty show an opportunity for improvements in pain and function; however, progressive glenoid radiolucencies may develop in these patients.
肩关节镜检查术后的关节软骨溶解是一种严重的并发症，常见于年轻患者。在非手术治疗方法均已用尽后，几乎没有可靠的治疗方案能够有效改善疼痛和功能。本研究的目的是检查一系列接受全肩关节置换术治疗的关节镜手术后发生关节软骨溶解患者的术中发现、影像学特征和临床结果。对11例（平均年龄39岁）关节镜检查术后出现肩关节软骨溶解的患者进行了回顾性研究。重点回顾了全肩关节置换术前的初次关节镜检查、X线片和功能结局评分，以及术中培养、组织学检查、X线片和最近一次随访的功能结局。所有患者在初次关节镜检查后平均26个月接受了全肩关节置换术。对术前和术后的X线片进行了评估，并使用经过验证的测量方法比较了结果。结果显示，肩关节外展（从89度提高到123度，P = 0.027）、外旋（从26度提高到48度，P = 0.037）、ASES总分（从30提高到77.5，P = 0.0039）和SST评分（从3提高到8，P = 0.0078）均有统计学意义的改善。10例患者主观上将其结果评为良好或优秀，1例为满意。肩关节镜检查术后的关节软骨溶解临床进展迅速，病因可能是多因素的。全肩关节置换术的早期结果显示疼痛和功能有改善的机会；然而，这些患者可能会出现进行性的关节盂透亮区。
