Hôpital Universitaire de Nantes, 44000 Nantes, France.
Clinique des cèdres d'Échirolles, 38130 Échirolles, France.
Orthop Traumatol Surg Res. 2017 Dec;103(8S):S189-S192. doi: 10.1016/j.otsr.2017.08.002. Epub 2017 Sep 2.
Surgical treatment of isolated posterior shoulder instability-a rare and often misdiagnosed condition-is controversial because of poor outcomes. Failure of physical therapy in symptomatic young athletes requires capsulolabral reconstruction or bone block procedures. The goal of this study was to report the outcomes of patients who have undergone surgical capsulolabral reconstruction and to look for risk factors that contribute to failure of this procedure.
We analyzed the outcomes of 101 patients who underwent capsulolabral reconstruction: 83 included retrospectively, 18 included prospectively. The procedures were performed alone or in combination with capsular shift, labral repair, closure of the rotator interval and notch remplissage. The primary endpoint was failure of the procedure, defined as recurrence of the instability and/or pain. We also determined the outcomes based on specific (Walch-Duplay, modified Rowe) and non-specific (Constant, resumption of activities) scores of shoulder instability.
The results were satisfactory despite a high failure rate: 35% in the retrospective cohort with 4.8±2.6 years' follow-up and 22% in the prospective cohort with 1.1±0.3 years' follow-up. The various outcome scores improved significantly. Ninety-two percent of patients returned to work and 80% of athletes returned to their pre-injury level of sports. Eighty-five percent of patients were satisfied or very satisfied after the surgery. No risk factors for failure were identified; however, failures were more common in older patients, those who underwent an isolated procedure and those who had unclassified clinical forms.
Treatment of posterior shoulder instability by capsulolabral reconstruction leads to good clinical outcomes; however, the recurrence rate is high.
4 - retrospective study.
孤立性后肩不稳的手术治疗（一种罕见且常被误诊的病症）存在争议，因为其治疗效果不佳。对于有症状的年轻运动员，若物理治疗无效，则需要进行肩袖盂唇重建或骨块手术。本研究旨在报告接受肩袖盂唇重建手术患者的治疗效果，并寻找导致该手术失败的风险因素。
我们分析了 101 例接受肩袖盂唇重建的患者的治疗效果：其中 83 例为回顾性纳入，18 例为前瞻性纳入。手术单独进行或与肩袖盂唇转移术、盂唇修复术、肩袖间隙闭合术和肩峰下间隙填充术联合进行。主要终点为手术失败，定义为不稳定和/或疼痛复发。我们还根据特定（Walch-Duplay、改良 Rowe）和非特定（Constant、活动恢复）评分来确定肩不稳定的治疗效果。
尽管失败率较高，但治疗效果仍令人满意：回顾性队列的 4.8±2.6 年随访中失败率为 35%，前瞻性队列的 1.1±0.3 年随访中失败率为 22%。各种治疗效果评分均显著改善。92%的患者重返工作岗位，80%的运动员重返受伤前的运动水平。85%的患者对手术结果满意或非常满意。未发现手术失败的风险因素；然而，在年龄较大的患者、接受单纯手术的患者和具有未分类临床类型的患者中，失败更为常见。
肩袖盂唇重建治疗后肩不稳可获得良好的临床效果，但复发率较高。
4-回顾性研究。
