The Edinburgh Shoulder clinic, Royal Infirmary of Edinburgh, Edinburgh, UK.
Scand J Med Sci Sports. 2013 Aug;23(4):387-405. doi: 10.1111/j.1600-0838.2012.01494.x. Epub 2012 Jun 28.
Anterior glenohumeral dislocation is common among athletes and may progress to recurrent instability. The pathoanatomy of instability and specific needs of each individual should be considered to prevent unnecessary absence from sport. Traditionally, primary dislocations have been managed with immobilization followed by rehabilitation exercises and a return to sporting activity. However, arthroscopic stabilization and external rotation bracing are increasingly used to prevent recurrent instability. In addition to the typical capsulolabral disruptions seen following a primary dislocation, patients with recurrent instability often have coexistent osseous injury to the humeral head and glenoid. In patients without significant bone loss, open soft-tissue stabilizations have long been considered the 'gold standard treatment' for recurrent instability, but with advances in technology, arthroscopic procedures have gained popularity. However, enthusiasm for arthroscopic repair has not been supported with evidence, and there is currently no consensus for treatment. In patients with greater bone loss, soft-tissue stabilization alone is insufficient to treat recurrent instability and open repair or bone augmentation should be considered. We explore the recent advances in epidemiology, classification, pathoanatomy and clinical assessment of young athletes with anterior shoulder instability, and compare the relative merits and outcomes of the different forms of treatment.
前肩盂肱关节脱位在运动员中很常见，可能会进展为复发性不稳定。为了防止运动员不必要地缺席运动，应该考虑不稳定的病理解剖和每个人的具体需求。传统上，初次脱位采用固定后康复锻炼和重返运动活动的方式进行治疗。然而，关节镜下稳定术和外旋支具越来越多地用于预防复发性不稳定。除了初次脱位后常见的典型盂唇撕裂外，复发性不稳定的患者常伴有肱骨头和肩盂的骨损伤。在没有明显骨丢失的患者中，开放性软组织稳定术长期以来一直被认为是复发性不稳定的“金标准治疗”，但随着技术的进步，关节镜手术越来越受欢迎。然而，关节镜修复的热情并没有得到证据的支持，目前对于治疗还没有共识。在骨丢失较大的患者中，单纯软组织稳定术不足以治疗复发性不稳定，应考虑开放修复或骨增强。我们探讨了年轻运动员前肩不稳定的流行病学、分类、病理解剖和临床评估的最新进展，并比较了不同治疗方式的优缺点和结果。
