O'Driscoll S W, Evans D C
Upper Extremity Reconstructive Service, St. Michael's Hospital, University of Toronto, Ontario, Canada.
J Bone Joint Surg Am. 1993 Feb;75(2):249-58. doi: 10.2106/00004623-199302000-00012.
The results of 204 open staple capsulorrhaphies, performed consecutively as treatment for recurrent anterior instability of the shoulder in 192 patients, were reviewed after an average of ten years (range, two to twenty years). The operation had been performed for recurrent dislocations in 88 per cent of the shoulders and for recurrent subluxations in the remaining 12 per cent. Postoperative instability--dislocation or subluxation--occurred in 22 per cent of the shoulders and increased in frequency logarithmically with the duration of follow-up. In more than half of these shoulders, the episodes of postoperative instability were recurrent. In one-third of the shoulders, the stapling had been combined with a Putti-Platt procedure; in the others, a muscle-splitting approach had been used. The rate of recurrent instability was 8 per cent in the shoulders in which a Putti-Platt procedure had been added and 29 per cent in the shoulders that had been treated by stapling alone. The difference was significant (p = 0.002). Loosening or migration of a staple, or penetration of the articular cartilage by a staple, occurred in twenty-four shoulders (12 per cent); the staple was removed from eighteen of them. There was no significant difference in the rate of loosening or migration between non-barbed and barbed staples (p = 0.92). Pain, physical restrictions, and osteoarthrosis were more frequent in patients who had complications associated with a staple. Although most of the patients (84 per cent of the shoulders) thought that they had benefited from the operation, approximately half (51 per cent of the shoulders) had pain and approximately half (50 per cent of the shoulders) said that the shoulder was sufficiently different from normal to affect the quality of life. Problems with the shoulder that had not been present before the operation caused several patients (5 per cent of the shoulders) to change occupations. The average ranges of internal and external rotation were slightly reduced. The subjective and objective results after the stapling procedure were not as good as previous reports have suggested, and we no longer recommend staple capsulorrhaphy for anterior instability of the shoulder, even when it is augmented by a Putti-Platt procedure.
对192例患者连续实施的204例开放性钉合关节囊缝合术的结果进行了回顾，这些手术用于治疗肩关节复发性前不稳定，平均随访十年（范围为2至20年）。88%的肩关节手术用于复发性脱位，其余12%用于复发性半脱位。术后不稳定（脱位或半脱位）发生在22%的肩关节中，且随着随访时间的延长频率呈对数增加。在这些肩关节中，超过一半术后不稳定发作是复发性的。三分之一的肩关节，钉合术与普蒂 - 普拉特手术联合使用；其他的则采用肌间隙入路。在加用普蒂 - 普拉特手术的肩关节中，复发性不稳定率为8%，而仅采用钉合术治疗的肩关节中为29%。差异具有统计学意义（p = 0.002）。24个肩关节（12%）出现钉松动、移位或钉穿透关节软骨；其中18个取出了钉子。无倒刺钉和有倒刺钉在松动或移位率上无显著差异（p = 0.92）。有钉相关并发症的患者疼痛、身体活动受限和骨关节炎更为常见。尽管大多数患者（84%的肩关节）认为手术使他们受益，但约一半（51%的肩关节）有疼痛，约一半（50%的肩关节）表示该肩关节与正常情况差异足够大，影响了生活质量。术前不存在的肩部问题导致数名患者（5%的肩关节）更换职业。内旋和外旋的平均活动范围略有减小。钉合术后的主观和客观结果不如先前报告所示，我们不再推荐使用钉合关节囊缝合术治疗肩关节前不稳定，即使联合普蒂 - 普拉特手术。
