The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A..
The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.
Arthroscopy. 2019 Jul;35(7):2014-2025. doi: 10.1016/j.arthro.2019.02.035. Epub 2019 Jun 14.
To investigate preoperative factors associated with selection of surgical treatment for anterior shoulder instability.
Patient demographics, initial physical examinations, and patient-oriented outcome questionnaires were collected prospectively from 26 shoulder surgeons at 10 sites. Symptom duration, number of dislocations, sport, history of prior stabilization procedure, Hill-Sachs/glenoid bone loss, pain level, and failure of conservative treatment were recorded. Statistical analysis was performed with Fisher's exact test and logistic regression analysis.
A total of 564 patients who underwent surgical treatment for anterior shoulder instability from November 2012 to June 2017 were enrolled. Of these, 426 shoulders underwent arthroscopic stabilization alone, 38 underwent arthroscopic stabilization with remplissage, 28 underwent open Bankart repair, and 72 underwent a Latarjet procedure. Predictors for undergoing Latarjet (P < .003) were symptom duration (75% had symptoms for >1 year), number of dislocations (47% had >5 dislocations), revision surgery (69%), Hill-Sachs lesion size (45% had a lesion between 11% and 20% of the humeral head), and glenoid bone loss (75% of Latarjet patients had 11% to 30% loss). Predictors for undergoing open Bankart repair (P < .001) were number of dislocations (32% had >5 dislocations), revision surgeries (54%), and glenoid bone loss (11% of open Bankart patients had 11% to 20% loss). History of prior shoulder surgery was the only significant predictor of open versus arthroscopic Bankart procedure. Prediction models showed athletes involved in high-risk sports were 2.61 times more likely to have a Latarjet (P < .01).
Indications for the Latarjet were: humeral and glenoid bone loss, duration of symptoms, number of dislocations, and revision stabilizations. Athletes involved in high-risk sports were more likely to undergo the Latarjet procedure, even if other predictive factors were not present. The open Bankart procedure was the least common procedure performed, with a history of prior shoulder surgery being the only predictor for use when treating recurrent instability.
Level II, prospective prognostic cohort investigation.
探讨与前肩不稳定手术治疗选择相关的术前因素。
前瞻性收集来自 10 个地点的 26 名肩关节外科医生的患者人口统计学资料、初始体格检查和以患者为导向的结果问卷。记录症状持续时间、脱位次数、运动、既往稳定术式史、Hill-Sachs/关节盂骨丢失、疼痛程度和保守治疗失败。采用 Fisher 精确检验和逻辑回归分析进行统计学分析。
共纳入 2012 年 11 月至 2017 年 6 月接受前肩不稳定手术治疗的 564 例患者。其中，426 例接受了关节镜下稳定术单独治疗，38 例接受了关节镜下稳定术加填充治疗，28 例接受了开放式 Bankart 修复术，72 例接受了 Latarjet 手术。接受 Latarjet 手术的预测因素（P <.003）为：症状持续时间（75%的患者症状持续时间>1 年）、脱位次数（47%的患者有>5 次脱位）、翻修手术（69%）、Hill-Sachs 病变大小（45%的患者病变大小在 11%至 20%的肱骨头之间）和关节盂骨丢失（75%的 Latarjet 患者有 11%至 30%的丢失）。接受开放式 Bankart 修复术的预测因素（P <.001）为：脱位次数（32%的患者有>5 次脱位）、翻修手术（54%）和关节盂骨丢失（11%的开放式 Bankart 患者有 11%至 20%的丢失）。既往肩部手术史是开放式与关节镜 Bankart 手术之间的唯一显著预测因素。预测模型显示，从事高风险运动的运动员接受 Latarjet 手术的可能性是接受开放式 Bankart 手术的 2.61 倍（P <.01）。
Latarjet 手术的适应证为：肱骨头和关节盂骨丢失、症状持续时间、脱位次数和翻修稳定术。从事高风险运动的运动员更有可能接受 Latarjet 手术，即使没有其他预测因素。开放式 Bankart 手术是最不常见的手术，既往肩部手术史是治疗复发性不稳定的唯一预测因素。
Ⅱ级，前瞻性预后队列研究。
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