Ma Hsiao-Li, Huang Hui-Kuang, Chiang En-Rung, Wang Shih-Tein, Hung Shih-Chieh, Liu Chein-Lin
Department of Orthopaedics, Taipei Veterans General Hospital, Taipei, Taiwan.
Orthopedics. 2012 Apr;35(4):e497-502. doi: 10.3928/01477447-20120327-15.
Treating shoulder multidirectional instability with an open stabilization procedure has been reported to have good results. However, few studies exist of arthroscopic plication, especially in overhead athletes. The purpose of this study was to evaluate the clinical outcomes of arthroscopic pancapsular plication for multidirectional instability in overhead athletes.Twenty-three athletes with symptomatic multidirectional instability were treated with arthroscopic pancapsular plication and evaluated at a mean follow-up of 36.3 months (range, 24-61 months). Mean patient age was 23.3 years (range, 19-33 years). Functional outcomes were evaluated with the American Shoulder and Elbow Surgeons (ASES) score, Constant shoulder score, and Rowe instability score. The degree of pain and range of motion were also recorded. All postoperative functional scores were rated good to excellent, with an average ASES score of 88.4 (range, 82-95), average Constant shoulder score of 88.1 (range, 81-100), and average Rowe instability score of 86.7 (range, 80-100). Five patients returned to the same level of competitive sports, and 18 returned to a limited level. All patients were satisfied with the stability postoperatively. No significant change was observed in postoperative range of motion, but patients who returned to a limited level of sports had lower functional scores and more pain than did those who fully returned to sports.Arthroscopic pancapsular plication for treating multidirectional instability in overhead athletes can provide good stability. However, the low rate of return to a full level of overhead sports is a problem. Further evaluation of the benefits of this procedure for overhead athletes with symptomatic multidirectional instability is needed.
据报道，采用开放稳定手术治疗肩部多向不稳定具有良好效果。然而，关于关节镜下折叠术的研究较少，尤其是在过头运动的运动员中。本研究的目的是评估关节镜下全关节囊折叠术治疗过头运动运动员多向不稳定的临床效果。23例有症状的多向不稳定运动员接受了关节镜下全关节囊折叠术，并在平均36.3个月（范围24 - 61个月）的随访中进行评估。患者平均年龄为23.3岁（范围19 - 33岁）。采用美国肩肘外科医师（ASES）评分、Constant肩关节评分和Rowe不稳定评分评估功能结果。还记录了疼痛程度和活动范围。所有术后功能评分均为良好至优秀，平均ASES评分为88.4（范围82 - 95），平均Constant肩关节评分为88.1（范围81 - 100），平均Rowe不稳定评分为86.7（范围80 - 100）。5例患者恢复到相同水平的竞技运动，18例恢复到有限水平。所有患者对术后的稳定性均满意。术后活动范围未见明显变化，但恢复到有限运动水平的患者功能评分较低，疼痛比完全恢复运动的患者更多。关节镜下全关节囊折叠术治疗过头运动运动员的多向不稳定可提供良好的稳定性。然而，完全恢复到过头运动全水平的比例较低是一个问题。需要进一步评估该手术对有症状多向不稳定的过头运动运动员的益处。
