Green Clare K, Scanaliato John P, Sandler Alexis B, Wynkoop Emily I, Goldman Adam, Turner Robert C, Czajkowski Hunter, Rolf Robert H, Parnes Nata
School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA.
Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
Orthop J Sports Med. 2023 Oct 16;11(10):23259671231202301. doi: 10.1177/23259671231202301. eCollection 2023 Oct.
Posterior instability has been reported to account for up to 24% of cases of shoulder instability in certain active populations. However, there is a paucity of data available regarding the risk factors associated with posterior glenoid bone loss.
To characterize the epidemiology of, and risk factors associated with, glenoid bone loss within a cohort of patients who underwent primary arthroscopic shoulder stabilization for isolated posterior-type glenohumeral instability.
Cross-sectional study; Level of evidence, 3.
This was a retrospective analysis of patients who underwent primary arthroscopic shoulder stabilization for posterior-type instability between January 2011 and December 2019. Preoperative magnetic resonance arthrograms were used to calculate posterior glenoid bone loss using a perfect circle technique. Patient characteristics and revision rates were obtained. Bone loss (both in millimeters and as a percentage) was compared between patients based on sex, age, arm dominance, sports participation, time to surgery, glenoid version, history of trauma, and number of anchors used for labral repair.
Included were 112 patients with a mean age of 28.66 ± 10.07 years; 91 patients (81.25%) were found to have measurable bone loss. The mean bone loss was 2.46 ± 1.68 mm (8.98% ± 6.12%). Significantly greater bone loss was found in athletes versus nonathletes (10.09% ± 6.86 vs 7.44% ± 4.56; = .0232), female versus male patients (11.17% ± 6.53 vs 8.17% ± 5.80; = .0212), and patients dominant arm involvement versus nondominant arm involvement (10.26% ± 5.63 vs 7.07% ± 6.38; = .0064). Multivariate regression analysis identified dominant arm involvement as an independent risk factor for bone loss ( = .0033), and dominant arm involvement ( = .0024) and athlete status ( = .0133) as risk factors for bone loss >13.5%. At the conclusion of the study period, 7 patients had experienced recurrent instability (6.25%).
The findings of this study are in alignment with existing data suggesting that posterior glenoid bone loss is highly prevalent in patients undergoing primary arthroscopic stabilization for posterior-type shoulder instability. Our results suggest that patients with dominant arm involvement are at risk for greater posterior glenoid bone loss. Athlete status and dominant arm involvement were identified as independent risk factors for bone loss >13.5%.
据报道，在某些活跃人群中，后向不稳占肩关节不稳病例的比例高达24%。然而，关于与肩胛盂后向骨质流失相关的危险因素的数据却很匮乏。
描述一组因单纯后向型盂肱关节不稳而接受初次关节镜下肩关节稳定手术的患者中肩胛盂骨质流失的流行病学特征及相关危险因素。
横断面研究；证据等级，3级。
这是一项对2011年1月至2019年12月期间因后向型不稳接受初次关节镜下肩关节稳定手术的患者的回顾性分析。术前磁共振关节造影采用完美圆形技术计算肩胛盂后向骨质流失情况。获取患者特征和翻修率。根据性别、年龄、优势臂、运动参与情况、手术时间、肩胛盂形态、创伤史以及用于盂唇修复的锚钉数量，比较患者之间的骨质流失情况（以毫米和百分比表示）。
纳入112例患者，平均年龄28.66±10.07岁；91例患者（81.25%）存在可测量的骨质流失。平均骨质流失为2.46±1.68毫米（8.98%±6.12%）。运动员与非运动员相比，骨质流失明显更多（10.09%±6.86对7.44%±4.56；P = 0.0232），女性患者与男性患者相比（11.17%±6.53对8.17%±5.80；P = 0.0212），优势臂受累患者与非优势臂受累患者相比（10.26%±5.63对7.07%±6.38；P = 0.0064）。多因素回归分析确定优势臂受累是骨质流失的独立危险因素（P = 0.0033），优势臂受累（P = 0.0024）和运动员身份（P = 0.0133）是骨质流失>13.5%的危险因素。在研究期间结束时，7例患者出现复发性不稳（6.25%）。
本研究结果与现有数据一致，表明在因后向型肩关节不稳接受初次关节镜稳定手术的患者中，肩胛盂后向骨质流失非常普遍。我们的结果表明，优势臂受累的患者肩胛盂后向骨质流失风险更高。运动员身份和优势臂受累被确定为骨质流失>13.5%的独立危险因素。
