Hovelius Lennart, Saeboe Modolv
Division of Surgery and Perioperative Science, Department of Orthopedics, Umeå University Hospital, Umeå, Sweden; Orthopedic Department, Gävle Hospital, Gävle, Sweden.
J Shoulder Elbow Surg. 2009 May-Jun;18(3):339-47. doi: 10.1016/j.jse.2008.11.004. Epub 2009 Feb 28.
Shoulder dislocation may cause arthropathy, but the natural history of this evolution is not well described. We therefore conducted a radiographic follow-up 25 years after the primary shoulder dislocation.
A prospective Swedish multicenter study (1978-1979) included 257 shoulders in 255 patients (age, 12-40 years) with a first-time anterior shoulder dislocation. After 25 years, 227 patients (229 shoulders) were alive and had follow-up. Radiographic imaging was performed in 223 shoulders (97%).
Shoulders were normal in 44%. Arthropathy was mild in 29%, moderate in 9%, and severe in 17%. Of the shoulders without a recurrence, 18% had moderate/severe arthropathy. The corresponding figures were 39% for shoulders that recurred once or more (without surgery) and 26% (16 of 62) for surgically stabilized shoulders. Seven of 221 patients (7 of 223 shoulders) were considered alcoholic at 25 years and all had severe arthropathy (P < .001). Other factors that correlated with moderate/severe arthropathy were age older than 25 years at primary dislocation (P = .01) and primary dislocation caused by high-energy sports activity (P = .009). Shoulders that had not recurred had less arthropathy than shoulders classified as recurrent (P = .047) or stabilized over time (P = .007). Sixty-two surgically stabilized shoulders had less arthropathy than those that became stable over time (P = .047). Mild arthropathy at 10 years was associated with moderate/severe arthropathy at 25 years in 19 of 30 shoulders (63%) compared with 13 of 146 (9%) classified as normal at 10 years (P < .001). Joint incongruence at 10 years was associated with moderate/severe arthropathy at 25 years (P = .001).
Age at primary dislocation, recurrence, high-energy sports, and alcohol abuse were factors associated with the development of arthropathy. Also shoulders without a recurrence were associated with arthropathy.
肩关节脱位可能导致关节病，但这种演变的自然史尚未得到充分描述。因此，我们在初次肩关节脱位25年后进行了影像学随访。
一项前瞻性瑞典多中心研究（1978 - 1979年）纳入了255例患者（年龄12 - 40岁）的257个首次前肩关节脱位的肩关节。25年后，227例患者（229个肩关节）存活并接受了随访。223个肩关节（97%）进行了影像学检查。
44%的肩关节正常。29%的肩关节有轻度关节病，9%为中度，17%为重度。在未复发的肩关节中，18%有中度/重度关节病。复发一次或多次（未手术）的肩关节相应比例为39%，手术稳定的肩关节为26%（62个中的16个）。221例患者中的7例（223个肩关节中的7个）在25岁时被认为有酗酒问题，且均有严重关节病（P <.001）。与中度/重度关节病相关的其他因素包括初次脱位时年龄大于25岁（P =.01）以及由高能体育活动导致的初次脱位（P =.009）。未复发的肩关节比归类为复发性或随时间稳定的肩关节关节病更少（P =.047）。62个手术稳定的肩关节比随时间稳定的肩关节关节病更少（P =.047）。10岁时为轻度关节病的30个肩关节中有19个（63%）在25岁时发展为中度/重度关节病，而10岁时归类为正常的146个肩关节中有13个（9%）出现这种情况（P <.001）。10岁时关节不匹配与25岁时中度/重度关节病相关（P =.001）。
初次脱位时的年龄、复发、高能体育活动和酗酒是与关节病发展相关的因素。此外，未复发的肩关节也与关节病有关。
