Cognetti Daniel J, Tenan Matthew S, Dickens Jonathan F, Patzkowski Jeanne C, Cote Mark P, Sansone Mikael, Sheean Andrew J
Department of Orthopedic Surgery, San Antonio Military Medical Center, San Antonio, Texas, U.S.A.
Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, U.S.A.
Arthrosc Sports Med Rehabil. 2023 Feb 18;5(2):e403-e409. doi: 10.1016/j.asmr.2023.01.007. eCollection 2023 Apr.
To report the frequencies of surgical stabilization procedures performed by military shoulder surgeons and to use decision tree analysis to describe how bipolar bone loss affects surgeons' decision to perform arthroscopic versus open stabilization procedures.
The Military Orthopaedics Tracking Injuries and Outcomes Network (MOTION) database was queried for anterior shoulder stabilization procedures from 2016 to 2021. A nonparametric decision tree analysis was used to generate a framework for classifying surgeon decision making based on specified injury characteristics (labral tear location, glenoid bone loss [GBL], Hill-Sachs lesion [HSL] size, and on-track vs off-track HSL).
A total of 525 procedures were included in the final analysis, with a mean patient age of 25.9 ± 7.2 years and a mean GBL percentage of 3.6% ± 6.8%. HSLs were described based on size as absent (n = 354), mild (n = 129), moderate (n = 40), and severe (n = 2) and as on-track versus off-track in 223 cases, with 17% (n = 38) characterized as off-track. Arthroscopic labral repair (n = 428, 82%) was the most common procedure, whereas open repair (n = 10, 1.9%) and glenoid augmentation (n = 44, 8.4%) were performed infrequently. Decision tree analysis identified a GBL threshold of 17% or greater that resulted in an 89% probability of glenoid augmentation. Shoulders with GBL less than 17% combined with a mild or absent HSL had a 95% probability of an isolated arthroscopic labral repair, whereas a moderate or severe HSL resulted in a 79% probability of arthroscopic repair with remplissage. The presence of an off-track HSL did not contribute to the decision-making process as defined by the algorithm and data available.
Among military shoulder surgeons, GBL of 17% or greater is predictive of a glenoid augmentation procedure whereas HSL size is predictive of remplissage for GBL less than 17%. However, the on-track/off-track paradigm does not appear to affect military surgeons' decision making.
Level III, retrospective cohort study.
报告军事肩部外科医生进行手术稳定手术的频率，并使用决策树分析来描述双极骨丢失如何影响外科医生决定进行关节镜下与开放稳定手术。
查询军事骨科跟踪损伤与结果网络（MOTION）数据库中2016年至2021年的前肩稳定手术。使用非参数决策树分析来生成一个基于特定损伤特征（盂唇撕裂位置、肩胛盂骨丢失[GBL]、希尔-萨克斯损伤[HSL]大小以及HSL是否在轨迹上）对外科医生决策进行分类的框架。
最终分析共纳入525例手术，患者平均年龄为25.9±7.2岁，平均GBL百分比为3.6%±6.8%。HSL根据大小描述为无（n = 354）、轻度（n = 129）、中度（n = 40）和重度（n = 2），在223例中描述为在轨迹上与不在轨迹上，其中17%（n = 38）为不在轨迹上。关节镜下盂唇修复（n = 428, 82%）是最常见的手术，而开放修复（n = 10, 1.9%）和肩胛盂增强术（n = 44, 8.4%）很少进行。决策树分析确定GBL阈值为17%或更高时，肩胛盂增强术的概率为89%。GBL小于17%且HSL为轻度或无HSL的肩部，单纯关节镜下盂唇修复的概率为95%，而中度或重度HSL导致关节镜下修复加 remplissage的概率为79%。根据算法和现有数据，不在轨迹上的HSL的存在对决策过程没有影响。
在军事肩部外科医生中，GBL为17%或更高可预测肩胛盂增强术，而HSL大小可预测GBL小于17%时的 remplissage手术。然而，在轨迹上/不在轨迹上的模式似乎不影响军事外科医生的决策。
III级，回顾性队列研究。
