Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY, USA.
J Shoulder Elbow Surg. 2021 Feb;30(2):229-236. doi: 10.1016/j.jse.2020.09.043. Epub 2020 Nov 6.
The purpose of this study was to identify differences related to race in preoperative and intraoperative findings of patients undergoing operative treatment for shoulder instability.
Data from the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort were used. Of 1010 patients, 995 provided race and ethnicity information and were included in the analyses. Demographic characteristics, injury history, radiographic and intraoperative findings, and preoperative patient-reported instability, pain, and function were compared (1) between white and minority patients and (2) in a subgroup analysis between white patients and the 3 largest minority groups. The Distressed Communities Index (DCI) score was recorded for each patient's home ZIP code. Multiple logistic regressions were performed to determine whether models consisting of race/ethnicity, insurance carrier, and/or DCI score were predictive of bone and cartilage loss at the time of surgery.
Compared with white patients, a greater percentage of US minority patients had ≥2 dislocations (68.0% vs. 57.1%, P = .01), which corresponded with more frequent articular cartilage lesions (62.2% vs. 51.0%, P = .007) and increased frequencies of glenoid bone loss > 10% (16.2% vs. 8.7%, P = .03) and Hill-Sachs lesions (68.6% vs. 56.0%, P = .004). Specifically, when compared with white patients, African American and Asian patients showed significantly increased frequencies of glenoid bone loss > 10% (19.7% of African American patients, 18.4% of Asian patients, and 8.9% of white patients; P = .01) and Hill-Sachs lesions (65.6%, 71.7%, and 52.4%, respectively; P = .02). Race was an independent predictor of articular cartilage lesions (P = .04) and the presence of Hill-Sachs lesions (P = .01). A higher DCI score (P = .03) and race (P = .04) were both predictive of having glenoid bone loss > 10%.
We found that minority race was associated with increased number of preoperative dislocations and increased frequency of articular cartilage and Hill-Sachs lesions at the time of surgery, and both minority race and an increased DCI score were associated with glenoid bone loss > 10%. Further research is needed to understand the underlying reason for these differences and to optimize care for all patients with shoulder instability.
本研究旨在确定接受手术治疗的肩不稳定患者术前和术中发现与种族相关的差异。
使用多中心骨科结局网络（MOON）肩不稳定队列的数据。在 1010 名患者中，995 名提供了种族和民族信息，并纳入分析。比较（1）白人和少数族裔患者之间，（2）白人患者和 3 个最大少数族裔群体之间的亚组分析中，人口统计学特征、损伤史、影像学和术中发现以及术前患者报告的不稳定、疼痛和功能。记录每位患者家庭邮政编码的受损社区指数（DCI）评分。进行多项逻辑回归分析，以确定种族/民族、保险承运人以及/或 DCI 评分组成的模型是否可预测手术时的骨和软骨丢失。
与白人患者相比，美国少数族裔患者的脱位次数≥2 的比例更高（68.0% vs. 57.1%，P =.01），相应的关节软骨损伤也更频繁（62.2% vs. 51.0%，P =.007），肩盂骨丢失>10%（16.2% vs. 8.7%，P =.03）和 Hill-Sachs 病变（68.6% vs. 56.0%，P =.004）的发生率也更高。具体而言，与白人患者相比，非裔美国人和亚洲患者的肩盂骨丢失>10%（19.7%的非裔美国患者、18.4%的亚洲患者和 8.9%的白人患者；P =.01）和 Hill-Sachs 病变（65.6%、71.7%和 52.4%；P =.02）的发生率明显更高。种族是关节软骨病变（P =.04）和 Hill-Sachs 病变存在（P =.01）的独立预测因素。较高的 DCI 评分（P =.03）和种族（P =.04）均与>10%的肩盂骨丢失相关。
我们发现，少数族裔与术前脱位次数增加以及手术时关节软骨和 Hill-Sachs 病变发生率增加有关，少数族裔和 DCI 评分升高均与>10%的肩盂骨丢失有关。需要进一步研究以了解这些差异的根本原因，并优化所有肩不稳定患者的治疗。
