Warner J J, Johnson D, Miller M, Caborn D N
Department of Orthopaedic Surgery, University of Pittsburgh, PA, USA.
J Shoulder Elbow Surg. 1995 Sep-Oct;4(5):352-64. doi: 10.1016/s1058-2746(95)80019-0.
Part I of our study consisted of sending a survey questionnaire to all members of the American Shoulder and Elbow Surgeons in which specific questions were asked about their technique of surgical repair in patients with anterior instability who had capsular laxity or injury in conjunction with marked inferior laxity. Part II is a description of the technique and preliminary results in 18 patients of a modified anterior-inferior capsular shift technique that tightens the inferior capsule with the shoulder positioned in abduction and external rotation and the superior capsule with the shoulder in adduction and external rotation. Of the members of the Society of the American Shoulder and Elbow Surgeons who responded to the survey, 80% agreed that preservation of external rotation was important and that shoulder position at the time of capsular repair might influence the ultimate range of motion obtained. However, no more than 50% of the respondents agreed on any one position for the arm when repairing the capsule. The most common responses for each position were flexion 0 degrees (49%) (range, 0 degrees to 40 degrees), abduction 30 degrees (24%) (range, 0 degrees to 80 degrees), and external rotation 30 degrees (37%) (range, 0 degrees to 70 degrees). The average postoperative follow-up period for the 18 patients was 27 months (range, 24 to 39 months). Of the 18 patients, 11 (61%) maintained symmetric motion; the others had minimal loss of external rotation compared with that of the contralateral shoulder. Six of eight patients with repair on the dominant side were able to return to full premorbid recreational throwing or racquet sports, and seven with repair on the nondominant side returned to full participation in overhead sports such as basketball and swimming. We conclude that this method of "selective" capsular repair may be a useful guideline to gauge the degree of capsular tightening in patients who have capsular injury or laxity.
我们研究的第一部分包括向美国肩肘外科医师协会的所有成员发送一份调查问卷，其中询问了他们针对伴有关节囊松弛或损伤并伴有明显下松弛的前不稳定患者的手术修复技术。第二部分描述了一种改良的前下关节囊移位技术在18例患者中的技术及初步结果，该技术在肩关节外展和外旋位收紧下关节囊，在内收和外旋位收紧上关节囊。在回复调查问卷的美国肩肘外科医师协会成员中，80%的人认为保留外旋很重要，并且关节囊修复时的肩部位置可能会影响最终获得的活动范围。然而，在修复关节囊时，对于手臂的任何一个位置，同意的受访者不超过50%。每个位置最常见的回复是屈曲0度（49%）（范围为0度至40度）、外展30度（24%）（范围为0度至80度）和外旋30度（37%）（范围为0度至70度）。18例患者的平均术后随访期为27个月（范围为24至39个月）。18例患者中，11例（61%）保持了对称运动；其他患者与对侧肩部相比，外旋仅有轻微丧失。优势侧接受修复的8例患者中有6例能够恢复到病前的完全娱乐性投掷或球拍运动，非优势侧接受修复的7例患者恢复到完全参与篮球和游泳等过头运动。我们得出结论，这种“选择性”关节囊修复方法可能是评估有关节囊损伤或松弛患者关节囊收紧程度的有用指导。
