Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, OH 45242, USA.
Arthroscopy. 2013 Jul;29(7):1142-8. doi: 10.1016/j.arthro.2013.04.004.
The objective of this 2-part study is to report on the etiology and disease progression (part I) and results of treatment (part II) of glenohumeral chondrolysis.
Forty patients presented with glenohumeral chondrolysis after treatment elsewhere. Twenty patients have been followed since their initial presentation and before prosthetic shoulder arthroplasty (group 1), and 20 patients were referred either for management of complications arising after shoulder arthroplasty or for evaluation only (group 2). All patients underwent standardized clinical and radiographic examination and completed shoulder-specific self-assessment questionnaires at initial presentation and after prosthetic shoulder arthroplasty for patients in group 1.
Thirty of 40 patients underwent subsequent arthroscopy for debridement, chondroplasty, capsular release, or a combination of these procedures. Of these, 23 patients (77%) required additional surgery, comprising 18 prosthetic shoulder arthroplasties performed at a mean 13 months of follow-up (range, 3 to 33 months), as well as 5 repeated arthroscopies. At most recent follow-up, 15 of 20 patients in group 1 had undergone shoulder arthroplasty, with improvements in active forward elevation from 92.6° to 140.0° (P < .0001), active abduction from 81.6° to 131.3° (P < .0001), active external rotation from 22.1° to 49.3° (P < .0001), and active internal rotation from the gluteal region to the T12 spinous process (P < .001). Pain scores improved from 6.4 to 3.4 (P < .01), and self-assessed outcome also improved significantly. Twelve patients in group 2 underwent shoulder arthroplasty, so overall 27 of 40 patients (68%) underwent prosthetic shoulder arthroplasty for chondrolysis at a mean of 32 months (range, 9 to 66 months) after the index procedure.
Postarthroscopic glenohumeral chondrolysis is a devastating condition that strikes young patients, responds poorly to arthroscopic interventions, and often requires shoulder arthroplasty within a few years. Patients can expect improved range of motion and outcome after shoulder arthroplasty, but pain relief is often incomplete.
Level IV, therapeutic case series.
本研究分为两部分，旨在报告盂肱关节软骨溶解症的病因和疾病进展（第 I 部分）以及治疗结果（第 II 部分）。
40 例患者在其他地方治疗后出现盂肱关节软骨溶解症。20 例患者自初次就诊和假体肩关节炎术前（第 1 组）起得到随访，20 例患者因肩关节炎术后并发症或仅因评估而转来（第 2 组）。所有患者均接受了标准化的临床和影像学检查，并在第 1 组患者进行假体肩关节炎术前和术后完成了肩部特定的自我评估问卷。
40 例患者中有 30 例接受了关节镜下清创术、软骨成形术、囊松解术或这些手术的联合治疗。其中，23 例（77%）需要进一步手术，包括 18 例假体肩关节炎，平均随访 13 个月（3 至 33 个月），以及 5 例重复关节镜检查。在最近的随访中，第 1 组的 20 例患者中有 15 例接受了肩关节炎手术，主动前向抬高从 92.6°增加到 140.0°（P<.0001），主动外展从 81.6°增加到 131.3°（P<.0001），主动外旋从 22.1°增加到 49.3°（P<.0001），主动内旋从臀区增加到 T12 棘突（P<.001）。疼痛评分从 6.4 分降至 3.4 分（P<.01），自我评估结果也显著改善。第 2 组的 12 例患者接受了肩关节炎手术，因此，40 例患者中有 27 例（68%）在指数手术后平均 32 个月（9 至 66 个月）后因软骨溶解症行假体肩关节炎手术。
关节镜下盂肱关节软骨溶解症是一种破坏性疾病，主要影响年轻患者，对关节镜干预反应不佳，常需在数年内行肩关节炎手术。患者在接受肩关节炎手术后可获得更好的关节活动度和结果，但疼痛缓解往往不完整。
IV 级，治疗性病例系列研究。
