University of Connecticut, Department of Orthopaedic Surgery, Farmington, Connecticut 06034, USA.
Am J Sports Med. 2011 Aug;39(8):1687-96. doi: 10.1177/0363546511405449. Epub 2011 May 12.
Traumatic labral tears involving the anterior, inferior, and posterior aspects of the glenoid fossa represent a unique subpopulation of shoulder instability.
This study was undertaken to evaluate prospectively the clinical results of patients who underwent arthroscopic repair of 270° labral tears.
Case series; Level of evidence, 4.
This was a prospective outcomes analysis of patients who underwent arthroscopic stabilization of a 270° labral tear. Inclusion criteria included patients with traumatic injury and primarily anteroinferior instability but several had posterior instability as well. Imaging revealed extensive labral injury in all patients. Indications for repair included symptomatic instability, 2+ anterior-inferior and posterior-inferior load-shift testing, and arthroscopic confirmation of labral lesions that extended anteriorly, inferiorly, and with extension to the midglenoid posteriorly. Exclusion criteria were SLAP (superior labrum anterior and posterior) lesions, revisions, and nontraumatic injuries. All patients underwent an arthroscopic repair utilizing modern suture anchor technique. Outcome measures included preoperative and postoperative Rowe, American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (SST), and Constant Murley scores. The Western Ontario Shoulder Instability Index (WOSI) and the Single Assessment Numeric Evaluation (SANE) scores were collected postoperatively. Failure was defined as any days missed from sport activity or work due to an instability event.
Twenty-three 270° labral repairs were performed in 21 patients by a single surgeon. Twenty shoulders in 19 patients (92%) were followed for a mean of 28 months (range, 14-47 months) postoperatively. The mean preoperative and postoperative outcome scores showed statistically significant improvements (P ≤ .001): Rowe (59 to 92), ASES (76 to 93), SST (9 to 11), and Constant scores (73 to 95). The mean SANE score was 91 of 100 and the mean WOSI score was 302. Three of the 20 shoulders (in 19 patients) had subsequent episodes of instability for a failure rate of 15%. One required a second procedure for continued instability for a revision rate of 5%. Two patients developed adhesive capsulitis postoperatively of which one required an arthroscopic arthrolysis.
Arthroscopic repair of these extensive labral injuries involving 270° of the glenoid fossa was an effective surgical treatment and restored mechanical stability of the shoulder. The arthroscopic approach allowed for complete visualization and repair of all labral pathology.
涉及肩胛盂窝前、下和后部位的创伤性盂唇撕裂代表了一种独特的肩关节不稳定亚群。
本研究旨在前瞻性评估接受关节镜下修复 270°盂唇撕裂患者的临床结果。
病例系列；证据水平，4 级。
这是一项对接受关节镜下 270°盂唇撕裂修复的患者进行的前瞻性结局分析。纳入标准包括创伤性损伤和主要前下不稳定，但也有部分患者存在后不稳定。影像学显示所有患者均有广泛的盂唇损伤。修复的指征包括症状性不稳定、前下和后下负荷移位试验 2+，以及关节镜确认盂唇病变向前、向下延伸，并向后延伸至肩胛盂中部。排除标准为 SLAP（上盂唇前后）病变、翻修和非创伤性损伤。所有患者均采用现代缝合锚钉技术进行关节镜下修复。结局测量包括术前和术后的 Rowe、美国肩肘外科医师协会（ASES）、简易肩部测试（SST）和 Constant-Murley 评分。术后收集 Western Ontario 肩不稳定指数（WOSI）和单评估数字评估（SANE）评分。失败定义为因不稳定事件而导致任何从运动或工作中错过的天数。
由一名外科医生对 21 名患者的 23 例 270°盂唇撕裂进行了修复。19 名患者中有 20 个肩关节（92%）平均随访 28 个月（范围，14-47 个月）。术前和术后的平均结局评分均显示出统计学显著改善（P≤0.001）：Rowe（59 至 92）、ASES（76 至 93）、SST（9 至 11）和 Constant 评分（73 至 95）。平均 SANE 评分为 100 分中的 91 分，平均 WOSI 评分为 302 分。20 个肩关节中有 3 个（19 名患者）随后出现不稳定发作，失败率为 15%。1 例因持续不稳定需要再次手术，翻修率为 5%。2 名患者术后发生粘连性关节囊炎，其中 1 例需要行关节镜下关节松解术。
关节镜下修复涉及肩胛盂窝 270°的这些广泛盂唇损伤是一种有效的手术治疗方法，可恢复肩关节的机械稳定性。关节镜入路可实现所有盂唇病变的全面可视化和修复。
