Roberts S B, Beattie N, McNiven N D, Robinson C M
Royal Infirmary Edinburgh, 51 Little France Crescent, EH16 4SA, UK.
Cumberland Infirmary, Newtown Road, Carlisle, CA2 7HY, UK.
Bone Joint J. 2015 Apr;97-B(4):520-6. doi: 10.1302/0301-620X.97B4.34989.
The natural history of primary anterior dislocation of the glenohumeral joint in adolescent patients remains unclear and there is no consensus for management of these patients. The objectives of this study were to report the natural history of primary anterior dislocation of the glenohumeral joint in adolescent patients and to identify the risk factors for recurrent dislocation. We reviewed prospectively-collected clinical and radiological data on 133 adolescent patients diagnosed with a primary anterior dislocation of the glenohumeral joint who had been managed non-operatively at our hospital between 1996 and 2008. There were 115 male (86.5%) and 18 female patients (13.5%) with a mean age of 16.3 years (13 to 18) and a mean follow-up of 95.2 months (1 to 215). During follow-up, 102 (absolute incidence of 76.7%) patients had a recurrent dislocation. The median interval between primary and recurrent dislocation was ten months (95% CI 7.4 to 12.6). Applying survival analysis the likelihood of having a stable shoulder one year after the initial injury was 59% (95% CI 51.2 to 66.8), 38% (95% CI 30.2 to 45.8%) after two years, 21% (95% CI 13.2 to 28.8) after five years, and 7% (95% CI 1.1 to 12.9) after ten years. Neither age nor gender significantly predicted recurrent dislocation during follow-up. We conclude that adolescent patients with a primary anterior dislocation of the glenohumeral joint have a high rate of recurrent dislocation, which usually occurs within two years of their initial injury: these patients should be considered for early operative stabilisation.
青少年患者肩肱关节原发性前脱位的自然病史仍不明确，对于这类患者的治疗也未达成共识。本研究的目的是报告青少年患者肩肱关节原发性前脱位的自然病史，并确定复发性脱位的危险因素。我们回顾性分析了1996年至2008年间在我院接受非手术治疗的133例诊断为肩肱关节原发性前脱位的青少年患者的临床和放射学资料。其中男性115例（86.5%），女性18例（13.5%），平均年龄16.3岁（13至18岁），平均随访95.2个月（1至215个月）。随访期间，102例（绝对发生率76.7%）患者出现复发性脱位。初次脱位与复发性脱位的中位间隔时间为10个月（95%可信区间7.4至12.6）。应用生存分析，初次受伤后1年肩关节保持稳定的可能性为59%（95%可信区间51.2至66.8），2年后为38%（95%可信区间30.2至45.8%），5年后为21%（95%可信区间13.2至28.8），10年后为7%（95%可信区间1.1至12.9）。随访期间，年龄和性别均不能显著预测复发性脱位。我们得出结论，肩肱关节原发性前脱位的青少年患者复发性脱位发生率高，通常在初次受伤后两年内发生：这些患者应考虑早期手术稳定治疗。
