William Beaumont Army Medical Center, Department of Orthopaedic Surgery, El Paso, Texas, U.S.A..
William Beaumont Army Medical Center, Department of Orthopaedic Surgery, El Paso, Texas, U.S.A.
Arthroscopy. 2022 Mar;38(3):743-749. doi: 10.1016/j.arthro.2021.09.003. Epub 2021 Sep 14.
To report mid-term outcomes of active-duty patients with anterior shoulder instability following our technique for double-pulley remplissage (DPR) with concomitant anterior labral repair.
All consecutive patients from 1/2010 through 12/2016 that underwent DPR by the senior surgeon with complete outcome scores were identified. All patients had experienced a shoulder dislocation following a traumatic event, and had subsequent instability recalcitrant to conservative management. Patients were excluded if they were lost to follow-up (3) of if they underwent stabilization procedures other than DPR (148). Outcome measures were completed by patients within 1 week prior to surgery and at latest follow-up. Twenty-four patients met the inclusion criteria for the study, and all were active-duty military at the time of surgery.
20/24 (83.3%) patients met the patient acceptable symptomatic state (PASS), while 21/24 (87.5%) achieved substantial clinical benefit (SCB) and 22/24 (91.7%) exceeded the minimal clinically important difference (MCID) for their operative shoulder, as determined by the American Shoulder and Elbow Surgeons (ASES) Score. 21/24 (87.5%) patients met the PASS, while 19/24 (79.2%) achieved SCB and 20/24 (83.3%) exceeded the MCID for their operative shoulder, as determined by the single assessment numeric evaluation (SANE). In addition, 23/24 (95.8%) patients exceeded the MCID for their operative shoulder, as determined by the Rowe Instability score. Preoperative and postoperative range of motion did not vary significantly. All patients had decreased pain postoperatively (P < .0001); 22/24 (91.67%) of patients remained on active-duty status. Failure rate, defined as recurrent subluxation or dislocation, was 4.2%.
Mid-term outcomes in this population of active-duty patients undergoing DPR for shoulder instability without glenoid bone loss demonstrate a statistically and clinically significant improvement in patient-reported outcomes, a significant decrease of pain and an overall return to active-duty rate of 91.67%.
IV, therapeutic case series.
报告采用双滑轮填充术（DPR）联合前盂唇修复治疗现役肩前不稳定患者的中期结果。
从 2010 年 1 月至 2016 年 12 月，对所有接受高级外科医生 DPR 治疗且完成完整结局评分的连续患者进行了鉴定。所有患者均经历过创伤性事件后的肩脱位，且经保守治疗后仍存在不稳定。如果患者失访（3 例）或接受了除 DPR 以外的稳定程序（148 例），则将其排除在外。手术前 1 周内和随访时由患者完成结局测量。24 例患者符合研究纳入标准，所有患者在手术时均为现役军人。
20/24（83.3%）例患者符合患者可接受的症状状态（PASS），而 21/24（87.5%）例患者达到了实质性临床获益（SCB），22/24（91.7%）例患者的美国肩肘外科医师（ASES）评分超过了手术侧的最小临床重要差异（MCID）。21/24（87.5%）例患者符合 PASS，而 19/24（79.2%）例患者达到了 SCB，且 20/24（83.3%）例患者的手术侧的 SANE 评分超过了 MCID。此外，23/24（95.8%）例患者的 Rowe 不稳定评分超过了手术侧的 MCID。术前和术后活动范围无显著差异。所有患者术后疼痛均减轻（P <.0001）；22/24（91.67%）例患者仍保持现役。失败率（定义为复发性半脱位或脱位）为 4.2%。
在无肩胛盂骨丢失的现役肩不稳定患者中进行 DPR 治疗的这一人群中，中期结果显示患者报告的结局有统计学和临床显著改善，疼痛显著减轻，总体恢复现役的比例为 91.67%。
IV，治疗性病例系列。
