Arciero Robert A, Spang Jeffrey T
Department of Orthopaedics, University of Connecticut, Farmington, Connecticut, USA.
Instr Course Lect. 2008;57:113-24.
Arthroscopic treatment of anterior glenohumeral instability has become increasingly common. As longer-term follow-up studies become available, certain trends dictating the success or failure of arthroscopic stabilization are becoming more evident. Bone defects are important predictors of clinical failure, and the recognition of bone loss and other pathoanatomic variables can help determine which patients will benefit from arthroscopic stabilization for anterior glenohumeral instability. Arthroscopic techniques for anterior shoulder instability must mirror the focus of open methods on retensioning the inferior glenohumeral ligament and restoring the anatomy of the anterior capsulolabral complex. Arthroscopic stabilization for anterior glenohumeral instability has achieved results comparable to those of open stabilization methods in properly selected patients. Advantages of arthroscopic treatment of shoulder instability include lower morbidity, decreased pain, the ability to treat other pathologies, and improved cosmesis. As arthroscopic treatment of recurrent shoulder instability becomes more commonplace, it is crucial to review the factors that influence the success or failure of arthroscopic instability procedures and to understand the guidelines for patient selection, surgical pearls and pitfalls, and adjunctive technical details designed to optimize results.
关节镜治疗肩肱关节前向不稳已变得越来越普遍。随着长期随访研究的开展，一些决定关节镜稳定手术成败的趋势变得愈发明显。骨缺损是临床失败的重要预测因素，识别骨质丢失及其他病理解剖变量有助于确定哪些患者能从关节镜稳定手术治疗肩肱关节前向不稳中获益。肩前不稳的关节镜技术必须与开放手术方法一样，着重于重新拉紧肩胛下韧带并恢复前关节囊盂唇复合体的解剖结构。对于合适选择的患者，关节镜治疗肩肱关节前向不稳已取得了与开放稳定手术相当的效果。关节镜治疗肩部不稳的优点包括较低的发病率、减轻疼痛、能够治疗其他病变以及改善美观。随着关节镜治疗复发性肩部不稳变得越来越普遍，回顾影响关节镜不稳手术成败的因素并了解患者选择指南、手术技巧及陷阱以及旨在优化手术效果的辅助技术细节至关重要。
