Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, New York, New York, USA.
Am J Sports Med. 2010 Dec;38(12):2558-72. doi: 10.1177/0363546510369250. Epub 2010 Jun 3.
The successful diagnosis and treatment of glenohumeral arthrosis in the young and active patient can be challenging to even the most experienced of clinicians. A thorough preoperative evaluation, including a detailed understanding of patient expectations, facilitates the selection of a treatment strategy. Arthroscopy is the gold standard for detecting chondral injuries, and it is increasingly used as an effective first line of management. In patients who fail arthroscopic debridement and reparative techniques, further treatment should proceed with an algorithmic decision-making approach encompassing patient-based and disease-based factors. Restorative and reconstructive techniques may provide improvements in pain and functional outcome while delaying the need for total shoulder arthroplasty, although the longevity of these treatments has yet to be established in the literature. Hemiarthroplasty and total shoulder arthroplasty have historically proven to be the most durable and reliable options in properly selected patients. However, concerns about progressive glenoid erosion and glenoid component loosening have led many to pursue alternative nonarthroplasty techniques for the management of arthrosis in active young individuals.
对于经验丰富的临床医生来说，成功诊断和治疗年轻且活跃的患者的肩锁关节炎也是具有挑战性的。彻底的术前评估，包括详细了解患者的期望，有助于选择治疗策略。关节镜检查是检测软骨损伤的金标准，并且越来越多地被用作有效的一线治疗方法。在关节镜清创和修复技术失败的患者中，进一步的治疗应采用包含基于患者和基于疾病因素的算法决策方法进行。修复和重建技术可以改善疼痛和功能结果，同时延迟全肩关节置换的需求，尽管这些治疗方法的长期效果尚未在文献中确定。半关节成形术和全肩关节置换术在适当选择的患者中已被证明是最持久和可靠的选择。然而，对于进行性肩胛盂侵蚀和肩胛盂部件松动的担忧，导致许多人寻求替代非关节置换技术来治疗活跃的年轻个体的关节炎。
