Bois Aaron J, Mayer Michelle J, Fening Stephen D, Jones Morgan H, Miniaci Anthony
Section of Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
JSES Int. 2020 May 26;4(3):574-583. doi: 10.1016/j.jseint.2020.04.015. eCollection 2020 Sep.
Management of bone loss in recurrent traumatic anterior shoulder instability remains a topic of debate and controversy in the orthopedic community. The purpose of this study was to survey members of 4 North American orthopedic surgeon associations to assess management trends for bone loss in recurrent anterior shoulder instability.
An online survey was distributed to all members of the American Shoulder and Elbow Surgeons, American Orthopaedic Society for Sports Medicine, and Canadian Orthopaedic Association and to fellow members of the Arthroscopy Association of North America. The survey comprised 3 sections assessing the demographic characteristics of survey respondents, the influence of prognostic factors on surgical decision making, and the operative management of 12 clinical case scenarios of varying bone loss that may be encountered in clinical practice.
A total of 150 survey responses were returned. The age of the patient and quantity of bone loss were consistently considered important prognostic criteria. However, little consensus was reached for critical thresholds of bone loss and how this affected the timing (ie, primary or revision surgery) and type of bony augmentation procedure to be performed once a critical threshold was reached, especially in the context of critical humeral and bipolar bone loss.
Consistent trends were found for the management of recurrent anterior shoulder instability in cases in which no bone loss existed and when isolated critical glenoid bone loss was present. However, inconsistencies were observed when isolated critical humeral bone loss and bipolar bone loss were present.
复发性创伤性前肩关节不稳的骨质流失管理在骨科领域仍是一个存在争议的话题。本研究的目的是调查4个北美骨科医师协会的成员，以评估复发性前肩关节不稳骨质流失的管理趋势。
向美国肩肘外科医师协会、美国运动医学骨科协会、加拿大骨科协会的所有成员以及北美关节镜协会的成员发放了一份在线调查问卷。该调查问卷包括3个部分，评估调查对象的人口统计学特征、预后因素对手术决策的影响以及临床实践中可能遇到的12种不同骨质流失情况的手术管理。
共收到150份调查问卷回复。患者年龄和骨质流失量一直被认为是重要的预后标准。然而，对于骨质流失的临界阈值以及一旦达到临界阈值后如何影响手术时机（即初次手术或翻修手术）和骨增强手术的类型，尤其是在严重肱骨和双极骨质流失的情况下，几乎没有达成共识。
在不存在骨质流失和存在孤立性严重肩胛盂骨质流失的复发性前肩关节不稳病例中，发现了一致的管理趋势。然而，当存在孤立性严重肱骨骨质流失和双极骨质流失时，观察到了不一致的情况。
