Mallon W J, Speer K P
Triangle Orthopaedic Associates, Durham, NC 27704.
J Shoulder Elbow Surg. 1995 Jan-Feb;4(1 Pt 1):54-64. doi: 10.1016/s1058-2746(10)80009-6.
Multidirectional instability (MDI) of the shoulder is a complex problem that is not yet well understood. Instability in several directions is termed MDI, but the precise definition, classification, cause, and optimal method of treatment remains elusive. The cause appears to be multifactorial, with biochemical and biomechanical abnormalities present in shoulders with MDI. The biomechanical factors responsible for preventing MDI include bony architecture, concavity-compression from the deepening of the glenoid by the labrum, stability from the ligaments, primarily the inferior glenohumeral ligament complex and the superior capsular structures, and muscular control by use of force couples, especially stabilization of the scapula. Current recommended treatment is initially nonoperative, with aggressive physical therapy aimed at strengthening the rotator cuff and the scapular stabilizers. Patients who fail to respond to a nonoperative regimen often improve with surgical stabilization, which is usually an inferior capsular shift or a variant of that procedure. After this surgery immobilization of the operated shoulder for 6 to 8 weeks is recommended by most authors.
肩关节多向不稳定（MDI）是一个尚未被充分理解的复杂问题。在多个方向上的不稳定被称为MDI，但精确的定义、分类、病因及最佳治疗方法仍不明确。其病因似乎是多因素的，MDI患者的肩部存在生化和生物力学异常。预防MDI的生物力学因素包括骨骼结构、盂唇加深盂窝产生的凹面压缩、韧带提供的稳定性（主要是下盂肱韧带复合体和上关节囊结构）以及通过力偶实现的肌肉控制，尤其是肩胛骨的稳定。目前推荐的治疗方法最初是非手术的，采用积极的物理治疗，旨在加强肩袖和肩胛骨稳定肌。对非手术治疗方案无反应的患者通常通过手术稳定治疗得到改善，手术通常是下关节囊移位术或该手术的变体。大多数作者建议在这种手术后将患侧肩部固定6至8周。
