University of Toronto Orthopaedic Sports Medicine (UTOSM) at Women’s College Hospital, Toronto, Ontario, Canada.
Am J Sports Med. 2013 Sep;41(9):2034-40. doi: 10.1177/0363546513492952. Epub 2013 Jun 20.
Factors contributing to recurrent dislocation, revision stabilization, and complications requiring reoperation after an initial shoulder stabilization procedure for instability have not been evaluated on a population level.
(1) To define the rate of ipsilateral revision stabilization, contralateral primary stabilization, postoperative dislocation, and complications after primary shoulder stabilization in a population cohort. (2) To understand which risk factors among patient, surgical, and provider factors influence these outcomes.
Cohort study; Level of evidence, 3.
All residents of Ontario, Canada, aged 16 to 60 years undergoing primary shoulder stabilization between July 2003 and December 2008 were identified from billing and hospital databases. Separate Cox proportional hazards survivorship models were built for the outcomes revision stabilization and postoperative physician-documented shoulder relocation (minimum 2-year follow-up). Model covariates included patient demographics (age, sex, preoperative dislocations), provider characteristics (surgeon volume, hospital academic status), and type of surgery (open, arthroscopic). The frequency and risk factors for contralateral stabilization were identified.
A total of 5904 patients (80.6% male; median age, 29 years) were identified. Arthroscopic stabilization was used in ~60% of cases in 2003, increasing to ~80% in 2008. The rates of postoperative dislocation were 6.9%, revision stabilization 4%, and contralateral primary stabilization 3.9%. Patients aged younger than 20 years had a 7.7% revision rate (hazard ratio [HR], 2.7; 95% confidence interval [CI], 1.7-4.2; P < .0001) and a 12.6% rate of postoperative physician-documented dislocation (HR, 2.4; 95% CI, 1.8-3.4; P < .0001), compared with 2.8% and 5.5%, respectively, in patients 29 years old (median cohort age). Patients with 3 or more preoperative dislocations in Ontario had an increased risk of revision (HR, 2.1; 95% CI, 1.5-3.0; P < .0001) and postoperative dislocation (HR, 10.6; 95% CI, 8.1-14.0; P < .0001). Revision was more common after arthroscopic (4.3%) compared with open (3.5%) stabilization (HR, 1.4; 95% CI, 1.02-1.98; P = .04). No provider factor was predictive, including surgeon volume. Reoperation rate for complications not related to recurrent instability was 0.23% (infection, 0.07%; manipulation under anesthesia, 0.15%).
The risks of revision stabilization and postoperative (either shoulder) dislocation were most influenced by young age (<20 years) and having had 3 or more preoperative dislocations. Complications requiring surgery are rare.
导致初次肩关节不稳定稳定术后再次脱位、翻修稳定和需要再次手术的并发症的因素尚未在人群水平上进行评估。
（1）在人群队列中定义初次肩关节稳定术后同侧翻修稳定、对侧初次稳定、术后脱位和并发症的发生率。（2）了解患者、手术和提供者因素中的哪些风险因素会影响这些结果。
队列研究；证据水平，3 级。
从 2003 年 7 月至 2008 年 12 月期间在安大略省接受初次肩关节稳定术的所有年龄在 16 至 60 岁的居民均从计费和医院数据库中确定。分别为翻修稳定和术后医生记录的肩部再移位（至少 2 年随访）建立单独的 Cox 比例风险生存模型。模型协变量包括患者人口统计学特征（年龄、性别、术前脱位）、提供者特征（手术医生数量、医院学术地位）和手术类型（开放、关节镜）。确定了对侧稳定的频率和危险因素。
共确定了 5904 例患者（80.6%为男性；中位年龄 29 岁）。2003 年约有 60%的患者接受了关节镜稳定术，到 2008 年这一比例增加到约 80%。术后脱位的发生率为 6.9%、翻修稳定率为 4%、对侧初次稳定率为 3.9%。年龄小于 20 岁的患者翻修率为 7.7%（风险比[HR]，2.7；95%置信区间[CI]，1.7-4.2；P <.0001），术后医生记录的脱位率为 12.6%（HR，2.4；95% CI，1.8-3.4；P <.0001），而 29 岁的患者分别为 2.8%和 5.5%。安大略省有 3 次或更多次术前脱位的患者翻修（HR，2.1；95% CI，1.5-3.0；P <.0001）和术后脱位（HR，10.6；95% CI，8.1-14.0；P <.0001）的风险增加。关节镜（4.3%）与开放（3.5%）稳定术相比，翻修更为常见（HR，1.4；95% CI，1.02-1.98；P =.04）。没有提供者因素是可预测的，包括手术医生数量。与复发性不稳定无关的并发症需要手术的再手术率为 0.23%（感染，0.07%；麻醉下手法复位，0.15%）。
翻修稳定和术后（任何一侧肩部）脱位的风险主要受年龄较小（<20 岁）和有 3 次或更多次术前脱位的影响。需要手术的并发症很少见。
