Frank Rachel M, Arciero Robert A, Erickson Brandon J, Trenhaile Scott T, Provencher Matthew T, Verma Nikhil N
Fellow, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Instr Course Lect. 2018 Feb 15;67:415-432.
The recognition and management of glenohumeral instability has become an increasingly important aspect of orthopaedic care. Substantial controversy exists with regard to the indications for soft-tissue stabilization versus bony augmentation in patients with glenohumeral instability, particularly among surgeons in the United States and Europe. Although bone loss procedures are frequently performed in the United States and abroad, surgical techniques and indications for bone loss procedures are different. Surgeons should understand current evidence-based indications for arthroscopic versus open soft-tissue stabilization in patients with anterior shoulder instability. Surgeons also should understand the importance of glenoid bone loss with regard to surgical decision making and the indications for Latarjet reconstruction versus allograft reconstruction. Patient-specific factors, including age, sex, sports participation (type and level of play), and the number of instability events that occur before presentation, affect surgical decision making. The technical pearls for successful arthroscopic stabilization, remplissage, open soft-tissue stabilization, and bony reconstruction of the glenoid rim that are discussed in this chapter may increase the likelihood of successful outcomes in patients with glenohumeral instability.
肩肱关节不稳的识别与处理已成为骨科治疗中日益重要的一个方面。在肩肱关节不稳患者中，对于软组织稳定术与骨增强术的适应证存在大量争议，尤其是在美国和欧洲的外科医生之间。尽管在美国国内外经常进行骨丢失手术，但骨丢失手术的手术技术和适应证有所不同。外科医生应了解当前基于证据的前肩不稳患者关节镜下与开放软组织稳定术的适应证。外科医生还应了解肩胛盂骨丢失在手术决策中的重要性以及Latarjet重建术与同种异体移植重建术的适应证。患者的特定因素，包括年龄、性别、运动参与情况（运动类型和水平）以及就诊前发生的不稳事件数量，都会影响手术决策。本章讨论的成功进行关节镜下稳定术、充填术、开放软组织稳定术以及肩胛盂边缘骨重建的技术要点，可能会增加肩肱关节不稳患者获得成功治疗结果的可能性。
