Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Arthroscopy. 2012 Oct;28(10):1337-43. doi: 10.1016/j.arthro.2012.03.011. Epub 2012 Jun 15.
The purpose of this study was to evaluate outcomes of a consistent arthroscopic stabilization technique for recurrent posterior instability.
Thirty-four consecutive shoulders with symptomatic recurrent posterior instability were treated with arthroscopic repair and evaluated at a mean follow-up of 36 months (range, 12 to 67 months). Two patients were excluded because of prior surgery, leaving 32 for further analysis. The mean age was 21.4 years (range, 15 to 33 years). There were 26 male and 6 female patients, and in 59% the dominant shoulder was affected. A known traumatic injury had occurred in 25 (78%), but only 2 (6%) had a documented dislocation. Arthroscopic repair was performed with the patient in the lateral decubitus position through an anterosuperior 12-o'clock viewing portal. Suture anchor repairs were performed in 30 cases and plication to the intact labrum in 4. A sling and derotation wedge were used for 4 weeks, followed by progressive active range of motion, with weight lifting at 3 months and return to contact sports at 6 months. Of the 34 cases, 22 met the inclusion and exclusion criteria and had complete preoperative and postoperative shoulder outcome scores.
Significant improvement (P = .001) from preoperatively to final follow-up was seen for American Shoulder and Elbow Surgeons scores, from 68 to 93; Simple Shoulder Test scores, from 9.3 to 11.6; and visual analog scale scores, from 3.5 to 0.8. All patients returned to their previous level of athletic activity. Two patients reported postoperative instability; none required reoperation. There were no other postoperative complications.
This study represents a consecutive series of patients with recurrent posterior instability who underwent arthroscopic posterior stabilization. In this population arthroscopic posterior labral repair and capsular plication provided significant clinical improvement and low rates of recurrent instability and revision surgery.
Level IV, therapeutic case series.
本研究旨在评估一种一致的关节镜稳定技术治疗复发性后向不稳定的结果。
对 34 例有症状的复发性后向不稳定的连续肩部进行关节镜修复，并在平均随访 36 个月（范围，12 至 67 个月）时进行评估。由于先前的手术，有 2 例患者被排除在外，因此剩下 32 例用于进一步分析。平均年龄为 21.4 岁（范围，15 至 33 岁）。有 26 名男性和 6 名女性患者，其中 59%的优势肩受影响。25 例（78%）有已知的创伤性损伤，但仅有 2 例（6%）有记录的脱位。关节镜修复在侧卧位进行，通过前上 12 点钟观察口。在 30 例中进行了缝线锚定修复，在 4 例中进行了完整的半月板修补。使用吊带和旋前楔形物 4 周，然后进行渐进性主动运动范围，3 个月后开始举重，6 个月后恢复接触性运动。在 34 例中，22 例符合纳入和排除标准，并具有完整的术前和术后肩部结果评分。
从术前到最终随访，美国肩肘外科医生评分（从 68 分提高到 93 分）、简单肩部测试评分（从 9.3 分提高到 11.6 分）和视觉模拟评分（从 3.5 分提高到 0.8 分）均有显著改善（P =.001）。所有患者均恢复到以前的运动水平。有 2 例患者报告术后不稳定，但均无需再次手术。无其他术后并发症。
本研究代表了一组连续的复发性后向不稳定患者，他们接受了关节镜后向稳定。在该人群中，关节镜下后外侧唇修复和囊修补术提供了显著的临床改善，且复发性不稳定和翻修手术的发生率较低。
IV 级，治疗性病例系列。
