Freehill Michael T, Murray Iain R, Calvo Emilio, Lädermann Alexandre, Srikumaran Uma
Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA 94305, USA.
Edinburgh Orthopaedics, The Royal Infirmary of Edinburgh, Edinburgh EH4 2XU, UK.
Biology (Basel). 2023 Feb 11;12(2):291. doi: 10.3390/biology12020291.
There is currently no consensus on immobilization protocols following shoulder surgery. The aim of this study was to establish patterns and types of sling use for various surgical procedures in the United States (US) and Europe, and to identify factors associated with the variations.
An online survey was sent to all members of the American Shoulder and Elbow Society (ASES) and European Society for Surgery of the Shoulder and Elbow (ESSSE). The survey gathered member data, including practice location and years in practice. It also obtained preferences for the type and duration of sling use after the following surgical procedures: arthroscopic Bankart repair, Latarjet, arthroscopic superior/posterosuperior rotator cuff repair (ARCR) of tears <3 cm and >3 cm, anatomic total shoulder arthroplasty (aTSA) and reverse TSA (rTSA), and isolated biceps tenodesis (BT). Relationships between physician location and sling type for each procedure were analyzed using Fisher's exact tests and post-hoc tests using Bonferroni-adjusted -values. Relationships looking at years in practice and sling duration preferred were analyzed using Spearman's correlation tests.
In total, 499 surgeons with a median of 15 years of experience (IQR = 9-25) responded, with 54.7% from the US and 45.3% from Europe. US respondents reported higher abduction pillow sling use than European respondents for the following: Bankart repair (62% vs. 15%, < 0.0001), Latarjet (53% vs. 12%, < 0.001), ARCR < 3 cm (80% vs. 42%, < 0.001) and >3 cm (84% vs. 61%, < 0.001), aTSA (50% vs. 21%, < 0.001) and rTSA with subscapularis repair (61% vs. 22%, < 0.001) and without subscapularis repair (57% vs. 17%, < 0.001), and isolated BT (18% vs. 7%, = 0.006). European respondents reported higher simple sling use than US respondents for the following: Bankart repair (74% vs. 31%, < 0.001), Latarjet (78% vs. 44%, < 0.001), ARCR < 3 cm (50% vs. 17%, < 0.001) and >3 cm (34% vs. 13%, < 0.001), and aTSA (69% vs. 41%, < 0.001) and rTSA with subscapularis repair (70% vs. 35%, < 0.001) and without subscapularis repair (73% vs. 39%, < 0.001). Increasing years of experience demonstrated a negative correlation with the duration of sling use after Bankart repair (r = -0.20, < 0.001), Latarjet (r = -0.25, < 0.001), ARCR < 3 cm (r = -0.14, = 0.014) and >3 cm (r = -0.20, < 0.002), and aTSA (r = -0.37, < 0.001), and rTSA with subscapularis repair (r = -0.10, = 0.049) and without subscapularis repair (r = -0.19, = 0.022. Thus, the more experienced surgeons tended to recommend shorter durations of post-operative sling use. US surgeons reported longer post-operative sling durations for Bankart repair (4.8 vs. 4.1 weeks, < 0.001), Latarjet (4.6 vs. 3.6 weeks, < 0.001), ARCR < 3 cm (5.2 vs. 4.5 weeks < 0.001) and >3 cm (5.9 vs. 5.1 weeks, < 0.001), aTSA (4.9 vs. 4.3 weeks, < 0.001), rTSR without subscapularis repair (4.0 vs. 3.6 weeks, = 0.031), and isolated BT (3.7 vs. 3.3 weeks, = 0.012) than Europe respondents. No significant differences between regions within the US and Europe were demonstrated.
There is considerable variation in the immobilization advocated by surgeons, with geographic location and years of clinical experience influencing patterns of sling use. Future work is required to establish the most clinically beneficial protocols for immobilization following shoulder surgery.
Level IV.
目前肩部手术后的固定方案尚无共识。本研究的目的是确定美国和欧洲各种手术程序中吊带使用的模式和类型，并确定与这些差异相关的因素。
向美国肩肘协会（ASES）和欧洲肩肘外科学会（ESSSE）的所有成员发送了一份在线调查问卷。该调查收集了成员数据，包括执业地点和执业年限。它还获取了以下手术后吊带使用类型和持续时间的偏好：关节镜下Bankart修复术、Latarjet手术、关节镜下3cm以下和3cm以上撕裂的肩袖上/后上修复术（ARCR）、解剖型全肩关节置换术（aTSA）和反式TSA（rTSA），以及单纯肱二头肌固定术（BT）。使用Fisher精确检验和采用Bonferroni校正P值的事后检验分析每种手术中医生所在地区与吊带类型之间的关系。使用Spearman相关检验分析执业年限与首选吊带持续时间之间的关系。
共有499名外科医生回复，他们的中位经验为15年（IQR = 9 - 25），其中54.7%来自美国，45.3%来自欧洲。美国受访者报告在以下手术中使用外展枕吊带的比例高于欧洲受访者：Bankart修复术（62%对15%，P < 0.0001）、Latarjet手术（53%对12%，P < 0.001）、3cm以下ARCR（80%对42%，P < 0.001）和3cm以上ARCR（84%对61%，P < 0.001）、aTSA（50%对21%，P < 0.001）以及有肩胛下肌修复的rTSA（61%对22%，P < 0.001）和无肩胛下肌修复的rTSA（57%对17%，P < 0.001），以及单纯BT（18%对7%，P = 0.006）。欧洲受访者报告在以下手术中使用简单吊带的比例高于美国受访者：Bankart修复术（74%对31%，P < 0.001）、Latarjet手术（78%对44%，P < 0.001）、3cm以下ARCR（50%对17%，P <
