Torg J S, Balduini F C, Bonci C, Lehman R C, Gregg J R, Esterhai J L, Hensal F J
J Bone Joint Surg Am. 1987 Jul;69(6):904-13.
A modified Bristow-Helfet-May procedure was performed for recurrent dislocation or subluxation of the glenohumeral joint in 207 patients (212 shoulders), whose average age at the time of surgery was 20.3 years (range, fourteen to forty-seven years). The procedure was modified by directing the coracoid segment and conjoined tendon over the superior border rather than through the substance of the subscapularis tendon and muscle. The indications were either documented recurrent anterior dislocation of the glenohumeral joint or subluxation with instability as demonstrated on examination with the patient under anesthesia. The procedure was evaluated on the basis of the rate of recurrence of dislocation and subluxation, postoperative complications, the patients' subjective evaluation, and the effect of the procedure on the motion of the glenohumeral joint and the strength of the muscles of the shoulder as related to overhead throwing. Eight (3.8 per cent) of the shoulders redislocated and ten (4.7 per cent) had one or more subjective episodes of subluxation after the procedure. Complications included postoperative infection in two patients and problems with the screw that required its removal in ten. One hundred and thirty-one (62 per cent) of the patients responded to a questionnaire regarding their subjective evaluation of the results of surgery. Eleven (8 per cent) were unable to perform daily activities that involved overhead work, and forty-five (34 per cent) stated that they still had some degree of discomfort or pain in the shoulder. One hundred and twenty-six patients (96.2 per cent) stated that they were happy with the results of the surgery and would have the procedure again. Thirty patients had Cybex testing of the muscles of the shoulder. Only three (16 per cent) of the nineteen athletes whose dominant arm had been operated on returned to their pre-injury level of throwing. Data obtained with regard to changes in the range of motion and strength of the glenohumeral joint indicate that this loss of throwing ability was not due solely to a loss of glenohumeral motion. It appeared to be also related to a concomitant loss of strength at the extreme of external rotation of the humerus and the initiation of internal rotation of the humerus.
对207例（212个肩关节）复发性肩肱关节脱位或半脱位患者实施了改良的布里斯托-赫尔费特-梅手术，手术时患者的平均年龄为20.3岁（范围为14至47岁）。该手术的改良之处在于，将喙突段和联合腱置于肩胛下肌腱和肌肉的上缘而非穿过其内部。手术指征为有记录的肩肱关节复发性前脱位或麻醉下检查显示不稳定的半脱位。根据脱位和半脱位的复发率、术后并发症、患者主观评价以及该手术对肩肱关节活动度和与过顶投掷相关的肩部肌肉力量的影响对该手术进行评估。术后有8个肩关节（3.8%）再次脱位，10个肩关节（4.7%）有一次或多次半脱位的主观发作。并发症包括2例术后感染，10例因螺钉问题需要取出螺钉。131例（62%）患者回复了关于手术结果主观评价的问卷。11例（8%）患者无法进行涉及过顶工作的日常活动，45例（34%）表示肩部仍有一定程度的不适或疼痛。126例（96.2%）患者表示对手术结果满意，愿意再次接受该手术。30例患者进行了肩部肌肉功能的赛百斯测试。在接受手术的优势臂的19名运动员中，只有3例（16%）恢复到了受伤前的投掷水平。关于肩肱关节活动度和力量变化的数据表明，这种投掷能力的丧失不仅仅是由于肩肱关节活动度的丧失。它似乎还与肱骨外旋极限和肱骨内旋起始时伴随的力量丧失有关。
