Depovere Tom, Pouliart Nicole
Department of Orthopedics and Traumatology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Jette, Belgium.
Eur J Orthop Surg Traumatol. 2019 Dec;29(8):1649-1657. doi: 10.1007/s00590-019-02484-6. Epub 2019 Jun 27.
Minor or anterosuperior shoulder instability (MSI) is a relatively new concept with other characteristics than recurrent anteroinferior instability (TUBS). MSI includes patients without history of dislocation, with non-specific clinical symptoms and signs but with indications of laxity of (SGHL)/MGHL with isolated injury of (SGHL)/MGHL seen during arthroscopy. TUBS patients typically present with recurrent anteroinferior instability with at least labral injury of the anterior band of the IGHL. In this study, we focus on the postoperative (rehabilitation) course. Our hypothesis is that its duration is prolonged in patients with MSI when compared to those with TUBS.
Thirty-five patients with isolated anterosuperior capsuloligamentous lesions identified during arthroscopic surgery (group I-MSI) and 65 with at least an anteroinferior capsuloligamentous lesion (group II-TUBS) completed a survey that included a questionnaire enquiring into relief of pain and return to activity, the Oxford Shoulder Instability Score (OSIS) and the Western Ontario Shoulder Instability index (WOSI). Final follow-up occurred at a mean of 76 months postoperatively.
Pain at night, at rest and during overhead activities disappeared later in group I than in group II (respectively, p = 0.03; 0.01; 0.01). Patients with MSI returned later to professional activities (p = 0.02) and to the same sport (p = 0.01). In addition, they had worse outcome as measured by OSIS (p = 0.01) and WOSI (p = 0.07).
Patients with MSI have poorer prospects regarding time to relief of pain, return to work and sports and outcome scores compared to patients with TUBS.
轻微或肩前上方不稳定（MSI）是一个相对较新的概念，具有与复发性肩前下方不稳定（TUBS）不同的特征。MSI包括无脱位病史、有非特异性临床症状和体征但在关节镜检查时显示（SGHL）/MGHL松弛且（SGHL）/MGHL孤立损伤的患者。TUBS患者通常表现为复发性肩前下方不稳定，至少伴有IGHL前束的盂唇损伤。在本研究中，我们关注术后（康复）过程。我们的假设是，与TUBS患者相比，MSI患者的康复时间会延长。
35例在关节镜手术中发现孤立性肩前上方韧带损伤的患者（I组 - MSI）和65例至少有肩前下方韧带损伤的患者（II组 - TUBS）完成了一项调查，其中包括一份询问疼痛缓解和恢复活动情况的问卷、牛津肩部不稳定评分（OSIS）和西安大略肩部不稳定指数（WOSI）。最终随访平均在术后76个月进行。
I组夜间、休息时和过头活动时的疼痛消失时间比II组晚（分别为p = 0.03；0.01；0.01）。MSI患者恢复职业活动的时间较晚（p = 0.02），恢复同一项运动的时间也较晚（p = 0.01）。此外，根据OSIS（p = 0.01）和WOSI（p = 0.07）测量，他们的结果更差。
与TUBS患者相比，MSI患者在疼痛缓解时间、恢复工作和运动以及结果评分方面的前景较差。
