Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway.
Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway.
Arthroscopy. 2024 Oct;40(10):2543-2552.e1. doi: 10.1016/j.arthro.2024.02.032. Epub 2024 Mar 5.
To analyze the results of the subscapular sling procedure developed for anterior shoulder instability in patients with less than 10% anterior glenoid bone loss.
Patients were treated surgically with the arthroscopic subscapular sling procedure. A semitendinosus graft was used to reconstruct the anterior labrum and to establish a sling suspension around the upper part of the subscapularis tendon. The patients were followed up with radiographs (at 12 and 24 months). Magnetic resonance imaging (MRI) of the shoulder region and clinical examinations were performed at 3, 12, and 24 months. Recurrent dislocation was the primary endpoint. The Western Ontario Shoulder Instability Index (WOSI) and MRI results were secondary outcome measures. An independent physiotherapist assessed residual instability and range of motion.
Fifteen patients were included with a dislocation rate of 0% after 24 months follow-up. There was a significant clinical improvement of the WOSI score from 57% (904) at baseline to 88% (241) at 24 months (P < .001). The proportion of patients with an improvement in the WOSI Total score larger than the estimated minimal clinically important difference was 100% both at 12 and 24 months. MRI showed an intact sling in all patients. External rotation was not significantly reduced (52° at baseline vs 47° at 24 months, P = .211). Flexion and abduction were significantly improved from 152° to 174° (P = .001) and 141° to 170° (P < .001) after 24 months. The surgical procedures were completed without any intraoperative complications.
The subscapular sling procedure resulted in low recurrent shoulder instability and improved patient-reported outcome measures at 24 months of follow-up.
Level IV, case series.
分析用于治疗前肩不稳且前盂肱关节骨丢失小于 10%患者的肩胛下悬吊术的结果。
对患者进行关节镜下肩胛下吊带手术治疗。使用半腱肌腱重建前盂唇，并在肩胛下肌上部建立吊带悬吊。对患者进行 X 线（12 个月和 24 个月时）随访。在 3、12 和 24 个月时进行肩部磁共振成像（MRI）和临床检查。复发性脱位为主要终点。Western Ontario 肩不稳定指数（WOSI）和 MRI 结果为次要结果。独立的物理治疗师评估残余不稳定性和活动范围。
15 例患者纳入研究，24 个月随访时脱位率为 0%。WOSI 评分从基线时的 57%（904）显著改善至 24 个月时的 88%（241）（P<0.001）。12 个月和 24 个月时，WOSI 总分改善大于估计的最小临床重要差异的患者比例均为 100%。所有患者的吊带均在 MRI 上显示完整。外旋角度无显著减少（基线时为 52°，24 个月时为 47°，P=0.211）。24 个月后，屈曲和外展明显改善，从 152°增加至 174°（P=0.001）和从 141°增加至 170°（P<0.001）。手术过程无任何术中并发症。
肩胛下吊带术可降低前肩不稳的复发率，并在 24 个月随访时改善患者的报告结局指标。
IV 级，病例系列研究。
