Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
Clin Orthop Surg. 2023 Aug;15(4):521-533. doi: 10.4055/cios23018. Epub 2023 Jul 13.
The shoulder, being the most mobile joint in the human body, is often susceptible to dislocations and subluxations more so than other joints. As such, shoulder instability constitutes a common complaint among patients worldwide, especially those who are young, participate in contact sports, and have increased innate flexibility in their joints. Management options in the setting of instability vary between conservative and surgical options that aim to mitigate symptoms and allow return of function. Surgical options can be arthroscopic and open, with a general shift among surgeons towards utilizing arthroscopic surgery in the past several decades. Nevertheless, open procedures still play a role in managing shoulder instability patients, especially those with significant bone loss, recurrent instability, coexisting shoulder pathologies, and high risk of failure with arthroscopic surgery. In these clinical settings, open procedures, like the Latarjet procedure, open Bankart repair, glenoid bone augmentation using iliac crest autograft or distal tibial allograft, and salvage options like glenohumeral arthrodesis and arthroplasty may show good clinical outcomes and low recurrence rates. Each of these open procedures possesses its own set of advantages and disadvantages and entails a specific set of indications based on published literature. It is important to cater treatment options to the individual patient in order to optimize outcomes and reduce the risk of complications. Future research on open shoulder stabilization procedures should focus on the long-term outcomes of recently utilized procedures, investigate different graft options for procedures involving bone augmentation, and conduct additional comparative analyses in order to establish concrete surgical management guidelines.
肩部是人体最灵活的关节，因此比其他关节更容易发生脱位和半脱位。因此，肩部不稳定是全世界患者常见的抱怨，尤其是那些年轻、参加接触性运动、关节先天柔韧性增加的患者。不稳定的治疗选择在保守治疗和手术治疗之间有所不同，旨在减轻症状并恢复功能。手术治疗可以是关节镜和开放性的，在过去几十年中，外科医生普遍倾向于使用关节镜手术。然而，开放性手术在治疗肩部不稳定患者方面仍然发挥着作用，尤其是那些存在严重骨丢失、反复不稳定、并存肩部病变以及关节镜手术失败风险高的患者。在这些临床情况下，开放性手术，如 Latarjet 手术、开放性 Bankart 修复术、使用髂嵴自体移植物或胫骨远端同种异体移植物进行盂肱关节骨增强术，以及挽救性手术，如盂肱关节融合术和关节置换术，可能会显示出良好的临床结果和低复发率。这些开放性手术中的每一种都有其自身的优点和缺点，并根据已发表的文献有特定的适应证。为了优化结果并降低并发症风险，为患者提供个体化的治疗选择非常重要。关于开放性肩部稳定术的未来研究应集中在最近使用的手术的长期结果上，研究涉及骨增强术的不同移植物选择，并进行额外的比较分析，以建立具体的手术管理指南。
