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多向性肩关节不稳定：治疗

Multidirectional Shoulder Instability: Treatment.

作者信息

Ruiz Ibán Miguel Angel, Díaz Heredia Jorge, García Navlet Miguel, Serrano Francisco, Santos Oliete María

机构信息

Hospital Universitario Ramon y Cajal, Cta Colmenar km9, 100, Madrid, 28046, Spain.

Hospital Asepeyo Coslada, Calle de Joaquín de Cárdenas, 2, 28823 Coslada, Madrid, Spain.

出版信息

Open Orthop J. 2017 Aug 31;11:812-825. doi: 10.2174/1874325001711010812. eCollection 2017.

DOI:10.2174/1874325001711010812
PMID:28979595
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5611704/
Abstract

BACKGROUND

The treatment of multidirectional instability of the shoulder is complex. The surgeon should have a clear understanding of the role of hiperlaxity, anatomical variations, muscle misbalance and possible traumatic incidents in each patient.

METHODS

A review of the relevant literature was performed including indexed journals in English and Spanish. The review was focused in both surgical and conservative management of multidirectional shoulder instability.

RESULTS

Most patients with multidirectional instability will be best served with a period of conservative management with physical therapy; this should focus in restoring strength and balance of the dynamic stabilizers of the shoulder. The presence of a significant traumatic incident, anatomic alterations and psychological problems are widely considered to be poor prognostic factors for conservative treatment. Patients who do not show a favorable response after 3 months of conservative treatment seem to get no benefit from further physical therapy. When conservative treatment fails, a surgical intervention is warranted. Both open capsular shift and arthroscopic capsular plication are considered to be the treatment of choice in these patients and have similar outcomes. Thermal or laser capsuloraphy is no longer recommended.

CONCLUSION

Multidirectional instability is a complex problem. Conservative management with focus on strengthening and balancing of the dynamic shoulder stabilizers is the first alternative. Some patients will fare poorly and require either open or arthroscopic capsular plication.

摘要

背景

肩关节多向不稳定的治疗较为复杂。外科医生应清楚了解每个患者中关节松弛、解剖变异、肌肉失衡及可能的创伤事件所起的作用。

方法

对相关文献进行综述，包括英文和西班牙文索引期刊。综述聚焦于肩关节多向不稳定的手术及保守治疗。

结果

多数肩关节多向不稳定患者最好先进行一段时间的物理治疗保守治疗；这应着重于恢复肩部动态稳定器的力量和平衡。存在重大创伤事件、解剖改变及心理问题被广泛认为是保守治疗的不良预后因素。保守治疗3个月后无良好反应的患者似乎无法从进一步的物理治疗中获益。当保守治疗失败时，有必要进行手术干预。开放关节囊移位术和关节镜下关节囊折叠术均被视为这些患者的首选治疗方法，且效果相似。不再推荐热或激光关节囊缝合术。

结论

肩关节多向不稳定是一个复杂问题。以加强和平衡肩部动态稳定器为重点的保守治疗是首选方案。一些患者预后较差，需要进行开放或关节镜下关节囊折叠术。

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The role of the scapula in preventing and treating shoulder instability.肩胛骨在预防和治疗肩关节不稳中的作用。
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