Pediatric Orthopaedic Surgery Service, Hospital for Special Surgery, New York, USA.
Assaf Harofeh Medical Center, Be'er Ya'akov, Israel.
Curr Opin Pediatr. 2018 Feb;30(1):49-56. doi: 10.1097/MOP.0000000000000566.
The purpose of this review is to discuss the epidemiology, pathoanatomy, diagnosis, and clinical management of pediatric and adolescent patients following a first-time shoulder dislocation.
Shoulder instability is becoming increasingly common as pediatric and adolescent patients engage in earlier organized sports competition. Recommended treatment following a first-time glenohumeral dislocation event in adolescents depends on several factors, but surgical stabilization is becoming more frequently performed. Surgical indications include bony Bankart lesion, ALPSA lesion, bipolar injury (e.g. Hill-Sachs humeral head depression fracture) or off-season injury in an overhead or throwing athlete. Complications following surgical treatment are rare but most commonly are associated with recurrent instability. Young children (eg. open proximal humerus growth plate), individuals averse to surgery, or in-season athletes who accept the risk of redislocation may complete an accelerated rehabilitation program for expedited return to play in the absence of the structural abnormalities listed above.
Following a first-time dislocation event in pediatric and adolescent patients, a detailed discussion of the risks and benefits of nonoperative versus operative management is critical to match the recommended treatment with the patient's injury pattern, risk factors, and activity goals.
本文旨在讨论首次发生肩关节脱位后儿科和青少年患者的流行病学、病理解剖学、诊断和临床管理。
随着儿科和青少年患者更早地参与有组织的运动竞赛，肩关节不稳定的情况越来越常见。青少年首次发生盂肱关节脱位后，推荐的治疗方法取决于多种因素，但手术固定的应用越来越广泛。手术指征包括骨 Bankart 损伤、ALPSA 损伤、双极损伤（如 Hill-Sachs 肱骨头凹陷骨折）或非赛季中上肢过头或投掷运动员的损伤。手术治疗后的并发症罕见，但最常见的是与复发性不稳定有关。年幼的儿童（例如，开放性肱骨近端生长板）、对手术有抵触的患者、或接受再脱位风险的赛季中运动员，如果不存在上述结构性异常，可以进行加速康复方案，以加快重返赛场的速度。
对于儿科和青少年患者首次发生脱位事件，详细讨论非手术与手术治疗的风险和益处对于根据患者的损伤模式、风险因素和活动目标匹配推荐的治疗方法至关重要。
