Hawkins R J, Mohtadi N G
University of Western Ontario, London.
Clin Orthop Relat Res. 1991 Nov(272):152-61.
The main areas of controversy in anterior shoulder instability are acute dislocation, recurrent instability, pain and instability in the "throwing athlete", and the role of arthroscopy. Treatment of the acute dislocation involves rest initially, followed by aggressive rehabilitation with protection of the shoulder until strength and motion have returned and pain and apprehension have resolved. Patients with recurrent instability may be seen with a variety of clinical scenarios. The surgical indications, pathology, and two methods of soft-tissue reconstruction are described along with an approach to postoperative rehabilitation. Return to sporting activity may be feasible by three months. The current thinking on the painful shoulder in the "throwing athlete" is outlined. Management must be based on an accurate diagnosis. Strengthening of the rotator cuff and scapular stabilizers is recommended with surgery to correct the pathology in those who fail this program. Arthroscopy is a valid tool in the diagnosis of anterior shoulder instability. The clinical significance of some intraarticular findings has not yet been clarified. Therapeutic use should be undertaken only in experienced hands, appreciating that failure of arthroscopic repair is higher than comparable open surgical techniques. The open approach to anterior stabilization is preferred.
前肩不稳的主要争议领域包括急性脱位、复发性不稳、“投掷运动员”的疼痛与不稳以及关节镜检查的作用。急性脱位的治疗最初需休息，随后进行积极的康复治疗并保护肩部，直至力量和活动恢复，疼痛和恐惧消失。复发性不稳的患者可能有多种临床情况。文中描述了手术指征、病理以及两种软组织重建方法，并介绍了术后康复方法。三个月后恢复体育活动可能是可行的。概述了当前对“投掷运动员”肩部疼痛的看法。治疗必须基于准确的诊断。对于未能通过该方案的患者，建议加强肩袖和肩胛稳定肌，并通过手术纠正病理状况。关节镜检查是诊断前肩不稳的有效工具。一些关节内发现的临床意义尚未阐明。仅应由经验丰富的人员进行治疗性应用，因为关节镜修复失败的几率高于类似的开放手术技术。前稳定的开放手术方法更为可取。
