Department of Orthopaedic Surgery, MedStar Washington Hospital Center, Washington, DC, U.S.A..
MedStar Georgetown University Hospital, Washington, DC, U.S.A.
Arthroscopy. 2018 Jan;34(1):12-20. doi: 10.1016/j.arthro.2017.06.044. Epub 2017 Aug 23.
To report outcomes of a conjoined tendon transfer procedure in a small case series of young active patients of various activity levels with recurrent traumatic anterior shoulder instability.
A retrospective chart review identified 10 consecutive patients who underwent conjoined tendon transfer (8 open and 2 arthroscopic) for anterior glenohumeral instability from January 2009 through December 2012. The indications were traumatic anterior shoulder instability with 25% or greater anterior glenoid bone loss, engaging Hill-Sachs lesion, or absent anterior-inferior labral tissue with anterior capsular tissue that did not readily hold sutures or a combination of these deficiencies. Patients did not undergo the procedure if they had healthy capsulolabral tissue and small bony defects or if they competed in high-level collision sports or were overhead throwers. The American Shoulder and Elbow Surgeons (ASES) questionnaire and a physical examination were completed preoperatively. Postoperatively, patients answered questions about shoulder stability and completed ASES and Western Ontario Shoulder Index questionnaires. A physical examination was performed postoperatively to assess range of motion.
Of 10 patients, 9 were available for follow-up. The mean age was 33.0 years (range, 18-51 years) at the time of surgery. Eight of nine patients underwent a physical examination at 31.3 ± 10.5 months (range, 24-58 months) postoperatively. There were no revisions or complications except for recurrent instability in 1 patient who underwent the arthroscopic procedure and reported gross deviation from the postoperative protocol. The ASES score improved significantly (62.8 ± 21.2 at baseline vs 89.2 ± 11.5 at final follow-up, P = .01). The postoperative Western Ontario Shoulder Index score was 74.5 ± 19.7. No significant change was found in external rotation in 90° of abduction (80.6° ± 12.9° at baseline vs 88.4° ± 6.1° at final follow-up, P = .11) or in flexion (145.6° ± 14.9° at baseline vs 153.1° ± 16.4° at final follow-up, P = .19). All patients returned to their previous activity level.
Stability was restored and no significant range-of-motion loss was observed in noncollision athletes who underwent conjoined tendon transfer. Recurrent instability occurred in 1 patient who underwent the arthroscopic procedure. There were no other complications.
Level IV, therapeutic case series.
报告在一系列不同活动水平的复发性创伤性前肩不稳定的年轻活跃患者中，进行联合肌腱转移手术的结果。
回顾性图表分析确定了 10 例连续接受联合肌腱转移（8 例开放性和 2 例关节镜下）治疗前肩盂肱关节不稳定的患者，这些患者的病因是创伤性前肩不稳定，伴 25%或更大的前盂肱骨丢失、Hill-Sachs 病变、或无前下盂唇组织伴前囊组织不易固定缝线，或存在这些缺陷的组合。如果患者有健康的囊盂唇组织和小的骨缺损，或从事高水平碰撞运动或投掷运动，则不进行该手术。术前完成美国肩肘外科医生（ASES）问卷和体格检查。术后，患者回答关于肩部稳定性的问题，并完成 ASES 和 Western Ontario 肩部指数问卷。术后进行体格检查以评估活动范围。
10 例患者中，9 例获得随访。手术时的平均年龄为 33.0 岁（范围，18-51 岁）。9 例中有 8 例在术后 31.3 ± 10.5 个月（范围，24-58 个月）接受了体格检查。除 1 例接受关节镜手术的患者发生复发性不稳定外，无其他翻修或并发症，该患者术后未按方案治疗。ASES 评分显著提高（基线时 62.8 ± 21.2，末次随访时 89.2 ± 11.5，P =.01）。术后 Western Ontario 肩部指数评分为 74.5 ± 19.7。外展 90°时外旋无明显变化（基线时 80.6° ± 12.9°，末次随访时 88.4° ± 6.1°，P =.11）或屈曲（基线时 145.6° ± 14.9°，末次随访时 153.1° ± 16.4°，P =.19）。所有患者均恢复到术前活动水平。
在接受联合肌腱转移的非碰撞运动员中，稳定性得到恢复，活动范围无明显丢失。1 例接受关节镜手术的患者发生复发性不稳定。无其他并发症。
IV 级，治疗性病例系列。
