Goth Anna Patricia, Klug Alexander, Gosheger Georg, Hiort Mirkka Lynn, Akgün Doruk, Schneider Kristian Nikolaus
BG Trauma Hospital Frankfurt am Main, Germany; Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital; Department of Plastic Surgery, Münster University Hospital; Center for Musculoskeletal Surgery, Charité Berlin.
Dtsch Arztebl Int. 2025 Feb 21;122(4):89-95. doi: 10.3238/arztebl.m2024.0254.
Traumatic anterior shoulder dislocation is the most common type of joint dislocation, with an incidence of 11 to 29 per 100 000 persons per year. Controversy still surrounds the recommendations for treatment and the available procedures for surgical stabilization.
This review is based on pertinent publications (2014-2024) that were retrieved by a selective search in the PubMed and Google Scholar databases. Meta-analyses and ran - domized controlled trials (RCTs) with evidence levels I and II were included.
The typical injury mechanism is forcible external rotation and abduction of the arm. The diagnosis is established by x-ray, which may be supplemented by magnetic resonance imaging (MRI) for the assessment of soft-tissue structures. The indication and type of surgical treatment depends on the patient's age, sex, activity level, and concomitant injuries. For purely soft-tissue injuries, arthroscopic Bankart repair is an established treatment, with reported significant reduction in the rate of recurrent instability after follow-up periods of up to 12 years. An accompanying bony injury of the dorsal humeral head (Hill-Sachs lesion), depending on its extent, may be an indication for the arthroscopic Remplissage procedure: this can lower the rate of recurrence, but it can also cause a postoperative restriction of external rotation. In cases of chronic instability, an arthroscopic or open Latarjet procedure and bone grafting can be per formed to augment the ventral glenoid articular surface. These procedures have likewise been reported to yield low rates of recurrent instability, but also higher complication rates.
The treatment of shoulder dislocation should be individually tailored. Although the reported results are promising, the evidence base remains weak. Prospective studies with larger case numbers are needed so that clear treatment algorithms can be established.
创伤性前肩关节脱位是最常见的关节脱位类型，每年发病率为每10万人中有11至29例。对于治疗建议和手术稳定的可用方法仍存在争议。
本综述基于通过在PubMed和谷歌学术数据库中进行选择性检索获得的相关出版物（2014 - 2024年）。纳入了证据等级为I和II的荟萃分析和随机对照试验（RCT）。
典型的损伤机制是手臂的强力外旋和外展。通过X线进行诊断，可辅以磁共振成像（MRI）以评估软组织结构。手术治疗的适应症和类型取决于患者的年龄、性别、活动水平和伴随损伤。对于单纯的软组织损伤，关节镜下Bankart修复是一种既定的治疗方法，据报道在长达12年的随访期后复发性不稳定率显著降低。肱骨头背侧的伴随骨损伤（Hill - Sachs损伤），根据其程度，可能是关节镜下Remplissage手术的适应症：这可以降低复发率，但也可能导致术后外旋受限。在慢性不稳定的情况下，可以进行关节镜或开放的Latarjet手术及骨移植以增加肩胛盂腹侧关节面。这些手术同样据报道复发性不稳定率较低，但并发症发生率较高。
肩关节脱位的治疗应个体化定制。尽管报道的结果很有前景，但证据基础仍然薄弱。需要进行更大病例数的前瞻性研究，以便建立明确的治疗算法。
