University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA.
St Joseph's University Medical Center, Department of Orthopaedic Surgery, Paterson, New Jersey, USA.
Am J Sports Med. 2023 May;51(6):1634-1643. doi: 10.1177/03635465211065403. Epub 2022 Feb 11.
Multiple studies have compared redislocation rates after stabilization and immobilization for patients experiencing a traumatic, first-time anterior shoulder dislocation (ASD).
To systematically review the literature to compare rates of recurrent instability and subsequent instability surgery in patients undergoing treatment for a first-time ASD with surgical stabilization versus shoulder immobilization.
Systematic review and meta-analysis; Level of evidence, 1.
A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify level 1 randomized studies that compared outcomes of surgical stabilization versus immobilization for treatment of primary ASD. The following search phrase was used: (glenohumeral OR anterior shoulder) AND (conservative OR nonoperative OR nonsurgical OR physiotherapy) AND (Bankart OR repair OR stabilization OR surgical OR surgery OR arthroscopic OR arthroscopy) AND (instability OR dislocation). Patients with soft tissue disruption alone as well as those with additional minor bony lesions (Hill-Sachs, Bankart) were included. Recurrent instability and subsequent instability surgery rates, the Western Ontario Shoulder Instability Index (WOSI), and range of motion were evaluated.
A total of 5 studies met inclusion criteria, including 126 patients undergoing surgical stabilization (mean age, 23.6 years; range, 15.0-39.0 years) and 133 patients undergoing treatment with sling immobilization only (mean age, 23.1 years; range, 15.0-31.0 years). Mean follow-up was 59.7 months. Overall, 6.3% of operative patients experienced recurrent instability at latest follow-up compared with 46.6% of nonoperative patients ( < .00001). Similarly, 4.0% of operative patients underwent a subsequent instability surgery compared with 30.8% of nonoperative patients ( < .00001). These same trends were demonstrated when data were isolated to nonoperative patients immobilized in internal rotation. When comparing the operative and nonoperative groups at latest follow-up, 1 study found significantly improved WOSI scores among operative patients ( = .035) and 1 study found significantly improved abducted external rotation in nonoperative patients ( = .02).
Patients, particularly active men in their 20s and 30s, undergoing treatment for a first-time ASD with a surgical stabilization procedure can be expected to experience significantly lower rates of recurrent instability and a significantly decreased need for a future stabilization procedure when compared with patients treated nonoperatively.
多项研究比较了初次创伤性前肩盂脱位（ASD）患者在稳定和固定后的再脱位率。
系统回顾文献，比较初次 ASD 患者接受手术稳定与肩部固定治疗后的复发性不稳定和随后的不稳定手术率。
系统回顾和荟萃分析；证据水平，1 级。
通过搜索 PubMed、Cochrane 图书馆和 Embase，对比较手术稳定与固定治疗原发性 ASD 的结局的 1 级随机研究进行系统回顾。使用以下搜索短语：（盂肱关节或前肩）和（保守或非手术或非手术或物理治疗）和（Bankart 或修复或稳定或手术或手术或关节镜或关节镜）和（不稳定或脱位）。纳入仅软组织破裂以及伴有其他较小骨损伤（Hill-Sachs、Bankart）的患者。评估复发性不稳定和随后的不稳定手术率、Western Ontario 肩不稳定指数（WOSI）和活动范围。
共有 5 项研究符合纳入标准，包括 126 例接受手术稳定治疗的患者（平均年龄 23.6 岁；范围 15.0-39.0 岁）和 133 例仅接受吊带固定治疗的患者（平均年龄 23.1 岁；范围 15.0-31.0 岁）。平均随访时间为 59.7 个月。总体而言，手术患者在末次随访时复发性不稳定的发生率为 6.3%，而非手术患者为 46.6%（<.00001）。同样，手术患者中有 4.0%接受了随后的不稳定手术，而非手术患者中有 30.8%（<.00001）。当将数据孤立到接受内旋固定的非手术患者时，也出现了同样的趋势。在末次随访时比较手术组和非手术组，1 项研究发现手术组的 WOSI 评分显著改善（=.035），1 项研究发现非手术组的外展外旋明显改善（=.02）。
初次 ASD 患者接受手术稳定治疗后，尤其是 20 多岁和 30 多岁的活跃男性，预计复发性不稳定的发生率显著降低，未来需要稳定治疗的可能性显著降低。
