Vavken Patrick, Tepolt Frances A, Kocher Mininder S
Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA; Alpha Clinic Zurich, Kraftstrasse 29, 8044 Zurich, Switzerland.
Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA.
J Shoulder Elbow Surg. 2016 Jun;25(6):907-12. doi: 10.1016/j.jse.2015.10.010. Epub 2016 Jan 14.
The objective of this study was to assess the outcome of open inferior capsular shift for multidirectional shoulder instability in patients with generalized ligamentous hyperlaxity or Ehlers-Danlos syndrome.
Data were obtained for 18 open inferior capsular shift surgeries in 15 adolescent patients with generalized ligamentous hyperlaxity or Ehlers-Danlos syndrome with a mean follow-up of 7.5 years. End points were subjective clinical outcome (pain, stability, satisfaction, return to sport), objective clinical outcome (recurrence, complications), and functional outcome scores (American Shoulder and Elbow Surgeons, 11-item version of the Disabilities of Arm, Shoulder and Hand).
Thirteen patients (87%) reported improved pain and stability and were satisfied with the procedure. Nine patients (64%) were able to return to sports. One patient (7%) was dissatisfied with continuous pain and recurrent instability and considered a surgical failure. Seven patients (47%) reported no further episodes of instability. The mean American Shoulder and Elbow Surgeons score at a mean of 7.5 years of follow-up was 88 ± 10 points, and the mean score for the 11-item version of the Disabilities of Arm, Shoulder and Hand was 14 ± 14 points.
The management of multidirectional shoulder instability in adolescent patients with generalized ligamentous hyperlaxity or Ehlers-Danlos syndrome is challenging. Open inferior capsular shift results in improvement in subjective and objective shoulder function and stability in adolescent patients with ligamentous hyperlaxity or Ehlers-Danlos who have failed nonoperative treatment. We found no effect of the recalled number of prior dislocations, laterality, and type of hyperlaxity on subjective and objective clinical outcomes.
Level IV; Case Series; Treatment Study.
本研究的目的是评估开放性下囊移位术治疗患有全身性韧带松弛或埃勒斯-当洛综合征患者的多向性肩关节不稳的疗效。
获取了15例患有全身性韧带松弛或埃勒斯-当洛综合征的青少年患者18例开放性下囊移位手术的数据，平均随访7.5年。终点指标包括主观临床疗效（疼痛、稳定性、满意度、恢复运动情况）、客观临床疗效（复发、并发症）以及功能疗效评分（美国肩肘外科医师学会评分、上肢、肩部和手部功能障碍的11项版本评分）。
13例患者（87%）报告疼痛和稳定性改善，对手术满意。9例患者（64%）能够恢复运动。1例患者（7%）对持续疼痛和复发性不稳定不满意，认为手术失败。7例患者（47%）报告无进一步的不稳定发作。平均随访7.5年时，美国肩肘外科医师学会平均评分为88±10分，上肢、肩部和手部功能障碍的11项版本平均评分为14±14分。
治疗患有全身性韧带松弛或埃勒斯-当洛综合征的青少年患者的多向性肩关节不稳具有挑战性。开放性下囊移位术可改善接受非手术治疗失败的患有韧带松弛或埃勒斯-当洛综合征的青少年患者的主观和客观肩部功能及稳定性。我们发现既往脱位次数、患侧以及松弛类型对主观和客观临床疗效无影响。
IV级；病例系列；治疗研究。
