Wheeler J H, Ryan J B, Arciero R A, Molinari R N
Orthopaedic Service, United States Military Academy, West Point, New York 10996.
Arthroscopy. 1989;5(3):213-7. doi: 10.1016/0749-8063(89)90174-6.
We evaluated the natural history of anterior shoulder dislocations in a young athletic population (cadets at the United States Military Academy) and compared conventional means of nonoperative treatment with early arthroscopic treatment (staple capsulorraphy or anterior glenoid abrasion). The rate of recurrent instability after a shoulder dislocation was 92% (35 of 38) in cadets treated nonoperatively. Strict adherence to a supervised nonoperative treatment program had no effect on the recurrence rate. All recurrences of instability occurred within 14 months of the initial injury. In comparison, arthroscopic treatment of acute shoulder dislocations has been successful thus far in 78% (7 of 9) of cadets followed for at least 14 months. With the high rate of recurrence of shoulder instability in young athletes, we believe that arthroscopic surgical intervention after the initial shoulder dislocation can dramatically lower the recurrence rate and should be considered as a treatment option in young athletes.
我们评估了年轻运动员群体（美国军事学院学员）前肩脱位的自然病程，并将传统非手术治疗方法与早期关节镜治疗（钉合关节囊缝合术或前盂唇磨削术）进行了比较。非手术治疗的学员肩脱位后复发性不稳定的发生率为92%（38例中的35例）。严格遵守有监督的非手术治疗方案对复发率没有影响。所有不稳定复发均发生在初次受伤后的14个月内。相比之下，到目前为止，对至少随访14个月的学员进行急性肩脱位的关节镜治疗成功率为78%（9例中的7例）。鉴于年轻运动员肩不稳定的高复发率，我们认为初次肩脱位后进行关节镜手术干预可显著降低复发率，应被视为年轻运动员的一种治疗选择。
