Amsterdam UMC, University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, the Netherlands; Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands.
Xpert Clinics, Department of Orthopedic Surgery, Amsterdam, the Netherlands; Spaarnegasthuis Academy, Orthopedic Department, Hoofddorp, the Netherlands.
Arthroscopy. 2023 Dec;39(12):2577-2586. doi: 10.1016/j.arthro.2023.07.060. Epub 2023 Aug 18.
Up to 60% of patients experience recurrence after a first traumatic anterior shoulder dislocation (FTASD), which is often defined as having experienced either dislocation or subluxation. Thus surgical intervention after FTASD is worthy of consideration and is guided by the number of patients who need to receive surgical intervention to prevent 1 redislocation (i.e., number needed to treat), (subjective) health benefit, complication risk, and costs. Operative intervention through arthroscopic stabilization can be successful in reducing recurrence risk in FTASD, as has been shown in multiple randomized controlled trials. Nevertheless, there is a large "gray area" for the indication of arthroscopic stabilization, and it is therefore heavily debated which patients should receive operative treatment. Previous trials showed widely varying redislocation rates in both the intervention and control group, meta-analysis shows 2% to 19% after operative and 20% to 75% after nonoperative treatment, and redislocation rates may not correlate with patient-reported outcomes. The literature is quite heterogeneous, and a major confounder is time to follow-up. Furthermore, there is insufficient standardization of reporting of outcomes and no consensus on definition of risk factors. As a result, surgery is a reasonable intervention for FTASD patients, but in which patients it best prevents redislocation requires additional refinement.
多达 60%的患者在前肩部创伤性脱位（FTASD）后会复发，通常将其定义为经历过脱位或半脱位。因此，在 FTASD 后进行手术干预是值得考虑的，并且可以通过需要接受手术干预以预防 1 次再脱位的患者数量来指导（即，需要治疗的数量），（主观）健康获益，并发症风险和成本。多项随机对照试验表明，关节镜下稳定术可成功降低 FTASD 的复发风险。尽管如此，关节镜下稳定术的适应证仍存在很大的“灰色地带”，因此，哪种患者应接受手术治疗存在很大争议。先前的试验显示，干预组和对照组的再脱位率差异很大，荟萃分析显示，手术后的再脱位率为 2%至 19%，非手术治疗后的再脱位率为 20%至 75%，而且再脱位率与患者报告的结局可能没有相关性。文献差异很大，一个主要的混杂因素是随访时间。此外，结局的报告没有充分标准化，并且对于危险因素的定义也没有共识。因此，手术是 FTASD 患者的合理干预措施，但在哪些患者中可以最好地预防再脱位仍需要进一步细化。
