Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati, OH 45242, USA.
Arthroscopy. 2013 Jul;29(7):1135-41. doi: 10.1016/j.arthro.2013.04.007.
The objective of this 2-part study is to report on the etiology, clinical findings, and predictors of disease progression (part I) and the results of treatment (part II) in a group of patients with glenohumeral chondrolysis.
Forty patients presented with glenohumeral chondrolysis after treatment elsewhere. Twenty patients have been followed up since their initial presentation before arthroplasty (group 1), and 20 patients were referred either for management of complications arising after prosthetic arthroplasty or for evaluation only (group 2).
Thirty-seven patients received an intra-articular pain pump (IAPP) delivering bupivacaine, and 3 patients had prominent suture anchors or tacks. Symptoms related to chondrolysis developed in patients at a mean of 9.8 months (range, 1 to 34 months) after the index procedure. Radiographs showed joint space obliteration in 30 of 40 patients at most recent follow-up or before arthroplasty. Of the patients receiving an IAPP delivering bupivacaine, the majority received 0.5% with epinephrine. Higher bupivacaine dose (P < .05) and female gender (P < .05) were associated with a longer interval to onset of symptoms. In addition, a shorter interval to onset of symptoms predicted the need for subsequent surgery (P < .05) and a shorter interval to second-look arthroscopy (P < .001).
Post-arthroscopic glenohumeral chondrolysis is a devastating and rapidly evolving condition that most often strikes young patients. The use of IAPPs delivering local anesthetics should be abandoned because nearly all cases of glenohumeral chondrolysis in this series were associated with their use.
Level IV, therapeutic case series.
本研究分为两部分，旨在报告一组肩盂肱关节软骨溶解症患者的病因、临床发现和疾病进展的预测因素（第一部分）以及治疗结果（第二部分）。
40 例患者曾在其他地方接受治疗后出现肩盂肱关节软骨溶解症。20 例患者自关节成形术前首次就诊以来一直随访（第 1 组），20 例患者因假体关节置换术后并发症而就诊或仅接受评估（第 2 组）。
37 例患者接受了关节内疼痛泵（IAPP），其中 3 例患者有明显的缝线锚钉或缝合钉。在索引手术后平均 9.8 个月（范围为 1 至 34 个月）出现与软骨溶解相关的症状。在最近一次随访或关节成形术前，40 例患者中有 30 例出现关节间隙消失。接受布比卡因关节内疼痛泵治疗的患者中，大多数接受的是 0.5%加肾上腺素。较高的布比卡因剂量（P<0.05）和女性（P<0.05）与症状出现的间隔时间较长相关。此外，症状出现的间隔时间较短预测了随后需要手术（P<0.05）和第二次关节镜检查的间隔时间（P<0.001）。
关节镜检查后盂肱关节软骨溶解症是一种破坏性的、迅速发展的疾病，通常发生在年轻患者中。应放弃使用局部麻醉剂的关节内疼痛泵，因为在本研究系列中几乎所有的肩盂肱关节软骨溶解症都与使用它们有关。
IV 级，治疗性病例系列。
