University of Pittsburgh Medical Center, UPMC St. Margaret, PA 15215, USA.
J Bone Joint Surg Am. 2012 Aug 15;94(16):1492-9. doi: 10.2106/JBJS.J.01696.
Recently there have been several evolving trends in the practice of shoulder surgery. Arthroscopic subacromial decompression has been performed with greater frequency by orthopaedic surgeons, and there has been considerable recent interest in arthroscopic rotator cuff repair. The purpose of this study was to identify trends in practice patterns for subacromial decompression and rotator cuff repair over time and in relation to the location of practice, fellowship training, and declared subspecialty of the surgeon.
We reviewed the American Board of Orthopaedic Surgery Part II database to identify patterns in the utilization of open and arthroscopic subacromial decompression and rotator cuff repair among candidates for board certification. All procedures involving only arthroscopic or open subacromial decompression and/or rotator cuff repair from 2004 to 2009 were identified. The rates of arthroscopic and open subacromial decompression and/or rotator cuff repair were compared in terms of year, geographic region, fellowship training, and declared subspecialty of the surgeon.
Between 2004 and 2009, 12,136 surgical procedures involving only arthroscopic or open subacromial decompression and/or rotator cuff repair were performed. There were significant differences in treatment with respect to year, geographic region of practice, declared subspecialty, and fellowship training (p < 0.001). There was a significant increase over time in the utilization of arthroscopy among all candidates (p < 0.001). Surgeons with sports medicine fellowship training or a sports-medicine-declared subspecialty performed significantly more subacromial decompressions and rotator cuff repairs arthroscopically than all other candidates (p < 0.001). During this time period, there was a significant decrease in the rate of arthroscopic subacromial decompression, both as an isolated procedure and combined with arthroscopic rotator cuff repair (p < 0.001).
From 2004 to 2009, there was a significant shift throughout the United States toward arthroscopic rotator cuff repair and subacromial decompression among young orthopaedic surgeons, with sports medicine fellowship-trained surgeons performing more of their procedures arthroscopically than surgeons with other training. However, there was an increasing frequency of arthroscopic rotator cuff repair performed without subacromial decompression, and, overall, there was a decrease in the frequency of isolated arthroscopic subacromial decompression over time.
肩部手术的实践最近出现了几种发展趋势。骨科医生更频繁地进行关节镜下肩峰下减压术，并且最近对关节镜下肩袖修复术的兴趣也很大。本研究的目的是确定随着时间的推移，以及与手术地点、 fellowship 培训和外科医生申报的亚专业相关的肩峰下减压术和肩袖修复术的实践模式的趋势。
我们回顾了美国骨科医师协会委员会第二部分数据库，以确定参与委员会认证的候选人中，开放和关节镜下肩峰下减压术和肩袖修复术的应用模式。从 2004 年到 2009 年，只涉及关节镜或开放肩峰下减压术和/或肩袖修复术的所有手术都被确定。根据年份、地理区域、fellowship 培训和外科医生申报的亚专业，比较关节镜和开放肩峰下减压术和/或肩袖修复术的比例。
2004 年至 2009 年间，仅进行关节镜或开放肩峰下减压术和/或肩袖修复术的手术有 12136 例。在治疗方面，年份、实践地理区域、申报的亚专业和外科医生的 fellowship 培训存在显著差异（p <0.001）。所有候选人的关节镜使用率均呈显著上升趋势（p <0.001）。具有运动医学 fellowship培训或运动医学申报亚专业的外科医生进行的肩峰下减压术和肩袖修复术明显多于其他所有候选人（p <0.001）。在此期间，关节镜下肩峰下减压术的比例，无论是单独进行还是与关节镜下肩袖修复术联合进行，均显著下降（p <0.001）。
从 2004 年到 2009 年，美国年轻的骨科医生在关节镜下肩袖修复术和肩峰下减压术方面发生了显著转变，运动医学 fellowship培训的外科医生比其他培训的外科医生更多地进行关节镜手术。然而，关节镜下肩袖修复术而不进行肩峰下减压术的频率越来越高，总体而言，孤立性关节镜下肩峰下减压术的频率随时间推移而降低。
