2009 年至 2030 年美国盂肱不稳外科稳定治疗的趋势和预测：Latarjet 术式的兴起和开放式 Bankart 修复的衰落。

Trends and projections in surgical stabilization of glenohumeral instability in the United States from 2009 to 2030: rise of the Latarjet procedure and fall of open Bankart repair.

机构信息

Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA.

出版信息

J Shoulder Elbow Surg. 2023 Aug;32(8):e387-e395. doi: 10.1016/j.jse.2023.03.011. Epub 2023 Apr 10.

DOI:10.1016/j.jse.2023.03.011

PMID:37044304

Abstract

BACKGROUND

Advances in surgical techniques have improved the ability to address recurrent glenohumeral instability via arthroscopic capsulolabral repair and bone-restoring procedures such as the Latarjet procedure. Given the paucity of studies analyzing temporal trends in the surgical management of glenohumeral instability, the purpose of this study was to assess trends in the treatment of anterior, posterior, and multidirectional instability over a 10-year period and model projections to 2030.

METHODS

Using the IBM Watson MarketScan national database, we identified all patients who underwent glenohumeral instability procedures from 2009 to 2018. Procedures were identified using Current Procedural Terminology codes for open Bankart, Latarjet, anterior bone block, posterior bone block, multidirectional capsular shift, and arthroscopic Bankart procedures. Sample weights provided by the database were used to calculate national estimates. US Census Bureau annual population data were used to calculate incidence. Future projections to 2030 were modeled using Poisson and linear regression.

RESULTS

There were an estimated 446,072 glenohumeral instability cases from 2009 to 2018. The per capita incidence (per 100,000) remained constant, from 14.8 in 2009 to 14.5 in 2018. Arthroscopic Bankart procedures comprised the highest number of procedures throughout the study period, accounting for 89% of all procedures in 2009 and 93% in 2018. The number of open Bankart procedures decreased by 65% from 2009 to 2018, whereas the number of Latarjet procedures showed a 250% increase over the same period. Patient demographics did not change over the study period, and male patients aged 18-25 years comprised the largest demographic group undergoing anterior instability procedures. Multidirectional instability procedures exhibited the least pronounced sex differences. Future modeling from 2018 to 2030 projected a continued steady rise in arthroscopic Bankart procedures (from 40,000 to 49,000 cases/yr), rapid growth in Latarjet procedures (from 1370 to 4300 cases/yr), and continued decline in open Bankart procedures (from 1000 to 250 cases/yr).

CONCLUSIONS

Arthroscopic Bankart repair continues to be the most common glenohumeral instability procedure in the United States. From 2009 to 2018, the incidence of open Bankart procedures declined whereas the incidence of Latarjet procedures markedly increased. Future projections to 2030 mirrored these findings. These data may provide an enhanced understanding of the evolution of surgical treatment of glenohumeral instability within the United States, laying the foundation for continued prospective studies into the appropriate indications and advancements in surgical techniques.

摘要

背景

手术技术的进步提高了通过关节镜囊状唇修复和骨修复手术（如 Latarjet 手术）来解决复发性肩盂肱关节不稳定的能力。鉴于缺乏分析肩盂肱关节不稳定手术治疗时间趋势的研究，本研究的目的是评估 10 年间治疗前、后和多向不稳定的趋势，并对 2030 年进行模型预测。

方法

使用 IBM Watson MarketScan 全国数据库，我们确定了 2009 年至 2018 年期间接受肩盂肱关节不稳定手术的所有患者。使用开放 Bankart、Latarjet、前骨块、后骨块、多向囊状移位和关节镜 Bankart 手术的现行程序术语代码识别手术。数据库提供的样本权重用于计算全国估计数。美国人口普查局的年度人口数据用于计算发病率。使用泊松和线性回归对 2030 年的未来预测进行建模。

结果

2009 年至 2018 年期间，估计有 446,072 例肩盂肱关节不稳定病例。人均发病率（每 10 万人）保持不变，从 2009 年的 14.8 降至 2018 年的 14.5。整个研究期间，关节镜 Bankart 手术的数量最多，占所有手术的 89%，2009 年占 93%，2018 年占 93%。2009 年至 2018 年期间，开放 Bankart 手术的数量减少了 65%，而 Latarjet 手术的数量增加了 250%。研究期间患者人口统计学特征没有改变，18-25 岁的男性患者是接受前不稳定手术的最大人群。多向不稳定手术的性别差异最小。从 2018 年到 2030 年的未来模型预测，关节镜 Bankart 手术将继续稳步上升（从 40,000 例/年增加到 49,000 例/年），Latarjet 手术将快速增长（从 1370 例增加到 4300 例/年），开放 Bankart 手术将持续下降（从 1000 例下降到 250 例/年）。

结论

关节镜 Bankart 修复仍然是美国最常见的肩盂肱关节不稳定手术。2009 年至 2018 年间，开放 Bankart 手术的发病率下降，而 Latarjet 手术的发病率显著上升。2030 年的未来预测反映了这些发现。这些数据可能会更好地了解美国肩盂肱关节不稳定手术治疗的演变，为进一步研究手术技术的适应证和进展奠定基础。