Ziegert Alexander, Ziegert Ina, Irlenbusch Ulrich
Orthopaedic Department, Marienstift Hospital, Arnstadt, Germany.
Acta Orthop Belg. 2009 Dec;75(6):727-35.
Postoperative function and recurrence rates are reportedly similar following open and arthroscopic procedures for recurrent anterior instability of the shoulder. However, various studies have reported greater restriction of shoulder mobility with open stabilisation. Sixty-two patients with post-traumatic recurrent anterior instability of the shoulder underwent anatomic reconstruction of the capsular-labral complex using a medial-based T capsular shift. They were investigated preoperatively and 53 of them were reexamined at an average of 41.5 months after operation. Function and stability improved: the Rowe score increased from 33.2 to 80.6, the Constant score from 81.5 to 89.8 points. Pre- and post-operative mobility of the affected shoulder was reduced in all planes of movement compared to the contralateral side. Passive mobility did not deteriorate in any direction with surgery. Passive adduction, forward flexion and external rotation in 90 degrees abduction of the arm improved significantly and active mobility rose to the values of the contralateral side. The restriction of mobility noted postoperatively thus appears as a consequence of the underlying pathology rather than of the surgical procedure. The recurrence rate after primary stabilisation was 1.6%. Based on these findings, the medial-based T capsular shift remains an appropriate surgical option in the treatment of chronic post-traumatic anterior instability of the shoulder.
据报道，对于复发性肩关节前不稳定，开放手术和关节镜手术术后的功能及复发率相似。然而，多项研究报告称开放稳定手术会导致肩关节活动度受限更明显。62例创伤后复发性肩关节前不稳定患者采用内侧蒂T形关节囊移位术对关节囊盂唇复合体进行解剖重建。对他们进行了术前评估，其中53例患者在术后平均41.5个月时接受了复查。功能和稳定性均有改善：Rowe评分从33.2分提高到80.6分，Constant评分从81.5分提高到89.8分。与对侧相比，患侧肩关节术前和术后在各个运动平面的活动度均降低。手术并未导致任何方向的被动活动度恶化。手臂外展90度时的被动内收、前屈和外旋显著改善，主动活动度上升至对侧水平。因此，术后出现的活动度受限似乎是由潜在病理状况而非手术操作导致的。初次稳定手术后的复发率为1.6%。基于这些发现，内侧蒂T形关节囊移位术仍是治疗慢性创伤后肩关节前不稳定的一种合适手术选择。
