Tang Xin, Chen Shiyi
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China.
Department of Sports Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, 200040, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 May 15;37(5):509-517. doi: 10.7507/1002-1892.202305002.
The shoulder joint is the most prone to dislocation in the whole body, and more than 95% of them are anterior dislocation. Improper treatment after the initial dislocation is easy to lead to recurrent anterior dislocation or anterior shoulder instability, and the outcomes following conservative treatment is poor. Anterior shoulder instability can damage the soft tissue structure and bone structure that maintain the stability of shoulder joint, among which bone structure is the most important factor affecting the stability of shoulder joint. Diagnosis should be combined with medical history, physical examination, and auxiliary examination. Currently, three-dimensional CT is the most commonly used auxiliary examination means. However, various bone defect measurement and preoperative evaluation methods based on three-dimensional CT and the glenoid track theory have their own advantages and disadvantages, and there is still a lack of gold standard. Currently, the mainstream treatment methods mainly include Bankart procedure, coracoid process transposition, glenoid reconstruction with free bone graft, Bankart combined with Remplissage procedure, and subscapular tendon binding tamponade, . Each of these procedures has its own advantages and disadvantages. For the diagnosis and treatment of anterior shoulder instability, there are still too many unknown, further research and exploration need to be studied.
肩关节是全身最容易发生脱位的关节,其中95%以上为前脱位。初次脱位后若治疗不当,容易导致复发性前脱位或肩关节前不稳定,保守治疗效果不佳。肩关节前不稳定会损害维持肩关节稳定的软组织结构和骨结构,其中骨结构是影响肩关节稳定性的最重要因素。诊断应结合病史、体格检查及辅助检查。目前,三维CT是最常用的辅助检查手段。然而,基于三维CT和肩胛盂轨迹理论的各种骨缺损测量及术前评估方法各有优缺点,仍缺乏金标准。目前主流的治疗方法主要包括Bankart手术、喙突移位术、游离骨移植盂重建术、Bankart联合Remplissage手术以及肩胛下肌腱捆绑填塞术等。这些手术各有优缺点。对于肩关节前不稳定的诊治,仍有太多未知之处,有待进一步研究探索。