Beirer M, Sandmann G H, Imhoff A B, Buchmann S
Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, München, Deutschland.
Oper Orthop Traumatol. 2016 Dec;28(6):430-437. doi: 10.1007/s00064-016-0465-5. Epub 2016 Jul 28.
To restore the physiologic anterior and posterior capsular volume to achieve an anatomic central contact point of the glenohumeral articulation and treatment of concomitant glenohumeral injuries due to posterosuperior impingement (PSI).
Plateauing of clinical improvement despite adequate nonsurgical treatment (for at least 6-12 months).
General contraindications for elective arthroscopic surgery.
Diagnostic arthroscopy of the glenohumeral joint through the posterior portal to assess stability of the biceps-labral complex even in the Abduction and External Rotation (ABER) position to confirm the diagnosis of PSI and to detect concomitant glenohumeral injuries. In most cases posterosuperior SLAP (superior labrum anterior posterior) repair or tenodesis of the long head of the biceps.
Arm sling for 6 weeks with limited range of motion. Free active range of motion of elbow and wrist. Limited shoulder external rotation for 6 weeks. Free shoulder range of motion from week 7, full daily life activities after 12 weeks. Modification of the postoperative management according to intraoperative findings.
At our hospital 18 overhead athletes (6 women, 12 men, mean age 31 years) with PSI without SLAP lesion or rotator cuff tear underwent isolated plication of the anteroinferior capsule after primary nonsurgical treatment. At a mean period of 9 months, 16 patients returned to their pre-injury sports activity level, 2 patients had to give up their sports due to persisting shoulder problems. At a mean follow-up of 27 months (range 12-55 months) the Walch Duplay score was on average 82.9 ± 8.3 for men and 73.8 ± 5.9 for women.
恢复生理前后关节囊容积，以实现盂肱关节的解剖学中心接触点，并治疗因后上撞击（PSI）导致的合并盂肱损伤。
尽管进行了充分的非手术治疗（至少6至12个月），临床改善仍趋于平稳。
择期关节镜手术的一般禁忌症。
通过后入路对盂肱关节进行诊断性关节镜检查，即使在外展和外旋（ABER）位也可评估肱二头肌-盂唇复合体的稳定性，以确诊PSI并检测合并的盂肱损伤。多数情况下，行后上SLAP（上盂唇前后部）修复或肱二头肌长头腱固定术。
使用手臂吊带6周，活动范围受限。肘部和腕部可自由进行主动活动。肩部外旋受限6周。从第7周开始逐渐恢复肩部活动范围，12周后可进行全部日常生活活动。根据术中发现调整术后管理。
在我院，18名患有PSI但无SLAP损伤或肩袖撕裂的上肢运动员（6名女性，12名男性，平均年龄31岁）在初次非手术治疗后接受了单纯下前关节囊折叠术。平均9个月时，16名患者恢复到受伤前的运动活动水平，2名患者因肩部问题持续存在而不得不放弃运动。平均随访27个月（范围12至55个月），男性的Walch Duplay评分平均为82.9±8.3，女性为73.8±5.9。
