Trivellas Myra, Hoyt Benjamin, Bokshan Steven, Dickens Jonathan F, Lau Brian C
Department of Orthopedic Surgery, Duke University, Durham, NC, USA.
Department of Surgery, Uniformed Services University, Bethesda, MD, USA.
Ann Jt. 2024 Jul 12;9:28. doi: 10.21037/aoj-23-45. eCollection 2024.
Posterior shoulder instability is an increasingly recognized phenomenon and comprises approximately 5% of all shoulder instability cases. Posterior shoulder instability presents a complex clinical challenge, particularly when associated with bone loss. Bone loss may be present in up to 25% of patients with posterior shoulder instability. Understanding its etiology, diagnosis, and treatment options is crucial for optimal patient outcomes. Young athletic individuals, especially football linemen and throwing athletes, are commonly affected, with symptoms ranging from insidious onset pain to noticeable changes in athletic performance. History, physical examination, and imaging, including radiographs and advanced three-dimensional imaging, play pivotal roles in diagnosis, with specific tests like the Jerk, Kim, and load and shift tests aiding in provocation. Posterior glenoid bone loss (pGBL), whether dysplastic, attritional, or acute, significantly impacts management decisions. When pGBL exceeds critical thresholds, soft tissue repair alone may be insufficient, necessitating glenoid reconstruction with bone block procedures. Both iliac crest autograft and distal tibial allograft (DTA) offer viable options, with considerations including donor site morbidity and graft integration. Surgical techniques for reverse Hill-Sachs lesions vary from subscapularis transfers to arthroscopic balloon osteoplasty, each aiming to restore native anatomy and prevent engagement. Bipolar bone loss, involving both glenoid and humeral head defects, presents additional challenges and may require combined soft tissue and bony procedures. Quantifying bone loss and understanding its implications are essential for surgical planning. While various techniques show promise, further research is needed to elucidate their long-term outcomes and refine treatment algorithms for posterior shoulder instability with bone loss.
肩关节后向不稳是一种日益受到认可的现象，约占所有肩关节不稳病例的5%。肩关节后向不稳带来了复杂的临床挑战，尤其是与骨质流失相关时。高达25%的肩关节后向不稳患者可能存在骨质流失。了解其病因、诊断和治疗选择对于实现最佳患者预后至关重要。年轻的运动员个体，尤其是橄榄球前锋和投掷运动员，通常会受到影响，症状从隐匿性发作的疼痛到运动表现的明显变化不等。病史、体格检查以及影像学检查，包括X线片和先进的三维成像，在诊断中起着关键作用，诸如Jerk试验、Kim试验以及负荷和移位试验等特定检查有助于激发症状。肩胛盂后向骨质流失（pGBL），无论是发育异常、磨损性还是急性的，都会显著影响治疗决策。当pGBL超过临界阈值时，仅软组织修复可能不足，需要采用骨块手术进行肩胛盂重建。髂嵴自体骨移植和胫骨远端异体骨移植（DTA）都提供了可行的选择，需要考虑供区并发症和移植物整合等因素。针对反Hill-Sachs损伤的手术技术各不相同，从肩胛下肌转移到关节镜下球囊骨成形术，每种技术都旨在恢复正常解剖结构并防止嵌顿。双极骨质流失，涉及肩胛盂和肱骨头缺陷，带来了额外的挑战，可能需要联合软组织和骨手术。量化骨质流失并了解其影响对于手术规划至关重要。虽然各种技术都显示出前景，但仍需要进一步研究来阐明其长期疗效，并完善针对伴有骨质流失的肩关节后向不稳的治疗算法。
