Department of Orthopedic Surgery, Ewha Womans University, College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Bumin Haeundae Hospital, Busan, Republic of Korea.
Arthroscopy. 2018 Aug;34(8):2287-2293. doi: 10.1016/j.arthro.2018.03.009. Epub 2018 May 24.
To evaluate the clinical outcomes and recurrence rates of arthroscopic stabilization procedures in young patients who had recurrent anterior shoulder instability with a glenoid bone erosion more than 20%, and to compare with those in patients with a glenoid bone erosion less than 20%.
A total of 161 patients who underwent an arthroscopic stabilization procedure for recurrent anterior shoulder instability with anterior glenoid bone erosions and at least 2 years of follow-up were included. Patients were divided into 2 groups based on the glenoid defect size (group I [32 patients]: erosion >20%, group II [129 patients]: erosion <20%). The clinical outcomes were compared using the American Shoulder Elbow Surgeons (ASES) score, Rowe score, and sports/recreation activity level between the 2 groups. Postoperative complications including instability recurrence were documented.
The mean glenoid defect size was 22.1 ± 2.1% in group I, and 12.2 ± 3.7% in group II. In group I, clinical outcomes were significantly improved after operation (ASES score: 57.9 ± 14.3 at initial, 88.9 ± 6.2 at the last visit, P = .001; Rowe score: 42.1 ± 15.6 at initial, 87.4 ± 7.6 at the last visit, P = .001). These results were inferior to the clinical outcomes of patients in group II (ASES score: 91.5 ± 12.7, P < .001; Rowe score: 89.3 ± 12.4, P = .01). Postoperative recurrences occurred in 5 patients (15.6%) in group I, whereas patients in group II showed 5.4% of recurrence rate (P = .05). Competent recoveries to sports/recreation activity were achieved in 84.4% of patients in group I.
Arthroscopic stabilization procedures for recurrent anterior shoulder instability in young patients with glenoid bone erosions more than 20% showed satisfactory clinical outcomes and recurrence rate, although these results were inferior to those of patients with glenoid erosions less than 20%. Arthroscopic stabilization procedures can be applied as the primary treatment of recurrent anterior shoulder instability with a large glenoid bone erosion for functional restoration and return to previous sports activity level.
Level III, retrospective comparative study.
评估盂肱前不稳伴盂骨缺损>20%的年轻患者行关节镜下稳定术的临床疗效和复发率，并与盂骨缺损<20%的患者进行比较。
回顾性分析 2006 年 1 月至 2017 年 1 月间因盂肱前不稳行关节镜下稳定术且至少随访 2 年的 161 例患者资料。根据盂骨缺损大小将患者分为两组：盂骨缺损>20%（32 例）为 A 组，盂骨缺损<20%（129 例）为 B 组。比较两组患者的美国肩肘外科医师协会（ASES）评分、Rowe 评分及运动/娱乐活动水平。记录两组术后并发症及复发情况。
A 组患者盂骨缺损平均为 22.1%±2.1%，B 组为 12.2%±3.7%。A 组术后 ASES 评分（由术前的 57.9±14.3 分提高至末次随访时的 88.9±6.2 分，P=.001）和 Rowe 评分（由术前的 42.1±15.6 分提高至末次随访时的 87.4±7.6 分，P=.001）均明显优于 B 组（ASES 评分：91.5±12.7，P<.001；Rowe 评分：89.3±12.4，P=.01）。A 组术后复发 5 例（15.6%），B 组复发 7 例（5.4%），两组间差异有统计学意义（P=.05）。A 组中有 84.4%的患者能恢复至术前的运动/娱乐水平。
盂肱前不稳伴盂骨缺损>20%的年轻患者行关节镜下稳定术可获得满意的临床疗效和复发率，但结果逊于盂骨缺损<20%的患者。关节镜下稳定术可作为盂骨缺损较大的盂肱前不稳的首选治疗方法，以恢复肩关节功能和重返术前运动娱乐水平。
关鹏飞,李众利,柴伟,等. 盂肱前不稳伴盂骨缺损>20%的关节镜下稳定术治疗[J]. 中华肩肘外科电子杂志,2022,10(4):270-276.
