Alkaduhimi Hassanin, Hilgersom N F J, Eygendaal Denise, van den Bekerom M P J, Oh Luke
Massachusetts General Hospital, Orthopaedic Sports Department, Harvard Medical School, Boston, Massachusetts, U.S.A 2 Shoulder and elbow unit, Joint Research, OLVG Amsterdam, the Netherlands.
Massachusetts General Hospital, Orthopaedic Sports Department, Harvard Medical School, Boston, Massachusetts, U.S.A.
Arch Bone Jt Surg. 2022 Jan;10(1):45-51. doi: 10.22038/ABJS.2021.41491.2121.
This study aimed to assess the results after soft-tissue posterior instability surgery and address possible challenges during these operations.
The databases of two tertiary hospitals were reviewed to identify patients treated for posterior shoulder instability between 2000 and 2015. Out of 198 treated patients, 19 cases underwent surgery with a mean follow-up of 35 months. Chart review was performed to obtain recurrence rates, revision rates, return to sport, persistent pain, subjective instability, subjective feeling of being better, complications, and range of motion after operative treatment of posterior shoulder instability. These outcomes were compared using the Fisher's exact and Mann-Whitney U tests.
After surgery, 6 (32%) patients had a recurrent subluxation, and 11 (58%) cases had persistent pain; moreover, 5 (26%) patients had a persistent feeling of instability, and 10 (53%) cases did not feel improvement after the operation. Furthermore, 10 (53%) patients required a revision, and there were 7 (37%) cases with a complication. Postoperatively, 75% of the patients had a full forward flexion, and 93% of the cases had full internal rotation; however, 64% of them had restrictions in external rotation.
There is a high rate of recurrent instability, need for revision, and complications after soft-tissue posterior instability surgery. Postoperative external rotation was impaired in most patients. Patients should be informed about these unsatisfactory results.
本研究旨在评估软组织后向不稳定手术后的结果,并探讨这些手术过程中可能面临的挑战。
回顾两家三级医院的数据库,以确定2000年至2015年间接受肩后向不稳定治疗的患者。在198例接受治疗的患者中,19例接受了手术,平均随访35个月。通过病历审查获取肩后向不稳定手术治疗后的复发率、翻修率、恢复运动情况、持续疼痛、主观不稳定感、主观改善感、并发症以及活动范围。使用Fisher精确检验和Mann-Whitney U检验对这些结果进行比较。
手术后,6例(32%)患者出现复发性半脱位,11例(58%)患者持续疼痛;此外,5例(26%)患者持续存在不稳定感,10例(53%)患者术后感觉无改善。此外,10例(53%)患者需要翻修,7例(37%)出现并发症。术后,75%的患者前屈正常,93%的患者内旋正常;然而,64%的患者外旋受限。
软组织后向不稳定手术后复发不稳定、需要翻修和出现并发症的发生率较高。大多数患者术后外旋功能受损。应告知患者这些不尽人意的结果。