B. G. Yow, S. M. Wade, M. D. Bedrin, Department of Orthopaedic Surgery, Uniformed Services University-Walter Reed National Military Medical Center, Bethesda, MD, USA.
J. P. H. Rue, The Orthopaedic Specialty Hospital, Mercy Medical Center, Baltimore, MD, USA.
Clin Orthop Relat Res. 2021 Apr 1;479(4):704-708. doi: 10.1097/CORR.0000000000001530.
Anterior instability has consistently been shown to be the most common type of glenohumeral instability. Recent studies have demonstrated a higher percentage of posterior and combined (anterior and posterior) instability than had previously been reported; however, this work has not been replicated recently in a particularly young military population, which may be representative of an especially athletic or high-demand group.
QUESTION/PURPOSE: What proportion of arthroscopic shoulder stabilization procedures are performed to address isolated anterior instability, isolated posterior instability, and combined instability in a young, military population?
Between August 2009 and January 2020, two sports medicine fellowship-trained surgeons performed arthroscopic shoulder surgery on 543 patients at a single institution. During that time, the indication to be treated with arthroscopic stabilization surgery was symptomatic glenohumeral instability, as diagnosed by the operative surgeon, that restricted patients from carrying out their military duties. Of those, 82% (443 of 543) could be evaluated in this retrospective study, while 18% (100 of 543) were excluded due to either incomplete data or because the procedure performed was not to address instability. No patient underwent an open stabilization procedure during this period. Of the 443 patients investigated, the mean age was 22 ± 4 years, and 88% (392 of 443 patients) were men. Instability type was characterized as isolated anterior, isolated posterior, or combined (anterior and posterior) according to the physician's diagnosis as listed in the patient's clinical records and operative reports after the particular capsulolabral pathology was identified and addressed.
Isolated anterior instability occurred in 47% of patients (210 of 443). Isolated posterior instability happened in 18% of patients (80 of 443), while combined anteroposterior instability occurred in 35% of patients (153 of 443).
Shoulder instability is common in the military population. Although anterior instability occurred most frequently, these findings demonstrate higher proportions of posterior and combined instability than have been previously reported. Surgeons should have a heightened suspicion for posterior and combined anteroposterior labral pathology when performing arthroscopic stabilization procedures to ensure that these instability patterns are recognized and treated appropriately. The current investigation examines a unique cohort of young and active individuals who are at particularly high risk for instability and whose findings may represent a good surrogate for other active populations that a surgeon may encounter.Level of Evidence Level III; therapeutic study.
先前的研究表明，盂肱关节前向不稳定是最常见的不稳定类型。最近的研究表明，后向和（前向和后向）联合不稳定的比例高于先前报道的比例；然而，这项工作最近在一个特别年轻的军事人群中尚未得到复制，这个人群可能代表了一个特别活跃或高需求的群体。
问题/目的：在一个年轻的军事人群中，关节镜肩袖稳定手术中，有多少比例是用于治疗单纯前向不稳定、单纯后向不稳定和联合不稳定？
在 2009 年 8 月至 2020 年 1 月期间，两位运动医学 fellowship培训的外科医生在一家单机构对 543 名患者进行了关节镜下肩部手术。在此期间，手术医生诊断为症状性盂肱关节不稳定，限制了患者执行军事任务，需要进行关节镜下稳定手术治疗。在这一回顾性研究中，82%（543 例中的 443 例）可进行评估，而 18%（543 例中的 100 例）因数据不完整或因所进行的手术不是为了解决不稳定问题而被排除在外。在此期间，没有患者接受开放性稳定手术。在 443 名患者中，平均年龄为 22 ± 4 岁，88%（392 例）为男性。根据患者临床记录和手术报告中列出的医生诊断，将不稳定类型分为单纯前向、单纯后向或（前向和后向）联合不稳定，这些诊断是在确定和处理特定的盂唇和盂肱韧带病变后做出的。
单纯前向不稳定发生在 47%的患者（443 例中的 210 例）。单纯后向不稳定发生在 18%的患者（443 例中的 80 例），而前向后向联合不稳定发生在 35%的患者（443 例中的 153 例）。
肩部不稳定在军事人群中很常见。尽管前向不稳定最常见，但这些发现表明后向和联合不稳定的比例高于先前报道的比例。在进行关节镜稳定手术时，外科医生应高度怀疑后向和联合前向后盂唇病变，以确保识别和适当治疗这些不稳定模式。目前的研究检查了一个独特的年轻和活跃人群，他们特别容易发生不稳定，他们的发现可能代表了其他活跃人群的一个很好的替代，外科医生可能会遇到这些人群。证据水平 III；治疗研究。
