Minkus M, Böhm E, Moroder P, Scheibel M
Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
Unfallchirurg. 2018 Feb;121(2):100-107. doi: 10.1007/s00113-017-0405-3.
In the current literature a consensus on the specific management of primary anterior traumatic shoulder instability has not been reached. While the steps of the initial diagnostic and therapeutic procedures are mostly well-defined, a variety of factors need to be considered for the planning of further treatment.
This article aims at giving an overview of the essential aspects of the initial management in the rescue center, clinical and radiological diagnostic procedures and the subsequent treatment options.
The content of this article is based on our own clinical experiences in combination with a systematic literature search for relevant clinical and baseline studies.
Besides a detailed anamnesis and clinical examination, X‑rays in two planes are important for the diagnosis. Potential nerve injuries or fractures need to be borne in mind before and after reduction of the joint and documented accordingly. The Matsen's maneuver can be recommended as it enables a careful repositioning. In rare cases of an irreducible shoulder dislocation due to soft tissue or bony articular interpositions, an open reduction might be necessary. Further therapeutic concepts should be adapted to patient age, activity level and accompanying pathologies, which determine the risk of a recurrent dislocation. A surgical approach for stabilization of the shoulder is highly recommended in cases of concomitant bony defects as well as in young and physically active patients.
A well-structured treatment plan is essential for the initial management of primary anterior traumatic shoulder instability. A generally applicable algorithm for further management is not yet established. The treatment should therefore be individually planned based on patient-specific characteristics.
在当前文献中，对于原发性创伤性前肩关节不稳的具体治疗方法尚未达成共识。虽然初始诊断和治疗程序的步骤大多已明确界定，但在规划进一步治疗时需要考虑多种因素。
本文旨在概述急救中心初始处理、临床和放射学诊断程序以及后续治疗选择的基本要点。
本文内容基于我们自己的临床经验，并结合对相关临床和基础研究的系统文献检索。
除了详细的病史采集和临床检查外，两个平面的X线检查对诊断很重要。在关节复位前后需要考虑潜在的神经损伤或骨折，并相应记录。推荐使用马特森手法，因为它能实现仔细的复位。在极少数因软组织或骨性关节嵌顿导致不可复位的肩关节脱位病例中，可能需要切开复位。进一步的治疗方案应根据患者年龄、活动水平和伴随的病理情况进行调整，这些因素决定了复发性脱位的风险。对于伴有骨质缺损的病例以及年轻且身体活跃的患者，强烈推荐采用手术方法稳定肩关节。
精心制定的治疗计划对于原发性创伤性前肩关节不稳的初始处理至关重要。尚未建立普遍适用的进一步处理算法。因此，应根据患者的具体特征进行个体化治疗规划。
