Shoulder and Elbow Surgery Unit, Department of Orthopaedic Surgery, Clínica Universidad de los Andes, Santiago, Chile.
Shoulder and Elbow Surgery Unit, Department of Orthopaedic Surgery, Clínica Dávila, Santiago, Chile.
Arch Orthop Trauma Surg. 2023 Jul;143(7):3857-3862. doi: 10.1007/s00402-022-04628-6. Epub 2022 Sep 23.
The primary objective of this study was to assess the incidence of recurrent glenohumeral instability in patients over 40 years with isolated rotator cuff (RC) repair for traumatic shoulder dislocation. The secondary objectives were to identify risk factors for glenohumeral recurrence after RC repair and to describe the causes and incidences of re-intervention.
In this retrospective cohort study, data of consecutive patients at a single trauma center between January 2014 and July 2019 were reviewed, and 84 patients with a mean age of 57 (range: 40-75) years and follow-up duration of 3.9 (2-6) years were included. The inclusion criteria were as follows: first traumatic anterior shoulder dislocation, reparable RC tear, primary arthroscopic RC repair, no labral or bony Bankart lesion repair, and at least 2 years of follow-up. Patients less than 40 years of age were excluded. Shoulder instability recurrences and surgical reinterventions were reviewed with medical records. Statistical analysis was performed for qualitative variables using the Chi-squared test. Statistical significance was set at P ≤ 0.05.
There was one patient with a redislocation episode (1.2%) at 2.5 years after surgery, who was surgically treated. Age, subscapular tears, bony Bankart injuries, humeral defects, and associated neurological injuries were not risk factors for recurrence in this study. Ten patients (11.9%) required reintervention. Nine patients (10.7%) re-tore their RCs.
Recurrent glenohumeral instability in active patients over 40 years with isolated RC repair after traumatic shoulder dislocation was infrequent, despite the incidence of significant Hill-Sachs defects, anterior glenoid defects, bipolar bone defects, size of the RC injury, and tendon re-tears. The incidence of re-interventions was 11.9%, with symptomatic RC retear as the main cause.
本研究的主要目的是评估因创伤性肩关节脱位接受单纯肩袖（RC）修复的 40 岁以上患者复发性肩盂肱不稳的发生率。次要目标是确定 RC 修复后肩盂复发的危险因素，并描述再干预的原因和发生率。
在这项回顾性队列研究中，我们对 2014 年 1 月至 2019 年 7 月在单一创伤中心连续就诊的患者数据进行了回顾，共纳入 84 例患者，平均年龄为 57 岁（范围：40-75 岁），随访时间为 3.9 年（2-6 年）。纳入标准如下：首次创伤性前肩脱位、可修复的 RC 撕裂、初次关节镜下 RC 修复、无盂唇或骨 Bankart 病变修复、随访时间至少 2 年。排除年龄小于 40 岁的患者。通过病历回顾肩不稳定复发和手术再干预情况。采用卡方检验对定性变量进行统计学分析。设定 P 值≤0.05 为统计学显著性差异。
术后 2.5 年有 1 例患者（1.2%）发生再脱位，经手术治疗。本研究中，年龄、肩胛下肌腱撕裂、骨 Bankart 损伤、肱骨头缺陷和合并神经损伤不是复发的危险因素。10 例患者（11.9%）需要再次手术干预。9 例患者（10.7%）肩袖再次撕裂。
对于因创伤性肩关节脱位接受单纯 RC 修复的 40 岁以上活跃患者，复发性肩盂肱不稳虽较为常见，但存在明显的 Hill-Sachs 缺损、前盂唇缺损、双极骨缺损、RC 损伤大小和肌腱再撕裂等情况，发生率仍较低。再干预的发生率为 11.9%，症状性 RC 再撕裂是主要原因。
