Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, UK.
Br Med Bull. 2010;96:75-92. doi: 10.1093/bmb/ldq009. Epub 2010 Mar 25.
Little attention has been focused on the most common risk factors for post-operative glenohumeral arthropathy in patients undergoing open and arthroscopic stabilization. We performed a literature search using Medline, Cochrane and Google Scholar using the keywords: 'Shoulder instability surgery' in combination with 'glenohumeral osteoarthrosis', 'recurrent shoulder dislocation' in combination with 'surgery' and 'complications'. We identified 33 published studies. There is evidence of long-term postoperative glenohumeral arthropathy in patients undergoing surgical management for shoulder instability. The Coleman methodology score showed great heterogeneity in terms of study design, patient characteristics, management methods and outcome assessment and generally low methodological quality. Follow-up length, age at first dislocation episode and limited external rotation have been shown to be strongly associated with shoulder arthropathy. There is no univocal outcome assessment available. To define the risk factors responsible for development of postoperative glenohumeral arthropathy, controversial findings have been detected. A common validated scale for clinical and imaging measurements for shoulder arthropathy is needed, so as to allow easier and more reliable comparison of outcomes in different studies. Patients should receive controlled imaging assessment (MR and radiographs) in addition to clinical examination. There is a need to perform appropriately powered randomized clinical trials comparing clinical and imaging related outcomes in patients undergoing open, arthroscopic and conservative management for shoulder instability. Standard diagnostic assessment, common and validated clinical and imaging scoring systems are needed.
人们对接受开放式和关节镜下稳定术治疗的患者术后肩肱关节病的最常见危险因素关注甚少。我们使用 Medline、Cochrane 和 Google Scholar 进行文献检索，关键词为：“肩不稳定手术”与“肱骨头关节病”，“复发性肩关节脱位”与“手术”和“并发症”。我们确定了 33 篇已发表的研究。有证据表明，接受肩不稳定手术治疗的患者存在长期术后肩肱关节病。Coleman 方法学评分显示，在研究设计、患者特征、管理方法和结果评估方面存在很大的异质性，且方法学质量普遍较低。随访时间、首次脱位发作时的年龄和外旋受限与肩关节炎强烈相关。目前还没有统一的结果评估方法。为了确定导致术后肩肱关节病发展的危险因素，已经发现了一些有争议的发现。需要一种通用的、经过验证的肩关节炎临床和影像学测量的评分标准，以便能够更容易和更可靠地比较不同研究的结果。除了临床检查外，患者还应接受受控的影像学评估（MR 和 X 线片）。需要进行适当的、有影响力的随机临床试验，比较接受开放式、关节镜下和保守治疗的肩不稳定患者的临床和影像学相关结果。需要进行标准的诊断评估、通用的、经过验证的临床和影像学评分系统。
