DeBerardino T M, Arciero R A, Taylor D C
Orthopaedic Surgery Service, United States Military Academy, West Point, NY 10996-1197, USA.
J South Orthop Assoc. 1996 Winter;5(4):263-71.
Arthroscopic stabilization for acute initial shoulder dislocation has been the subject of thorough investigation at West Point over the past decade in an attempt to improve on the natural history of shoulder instability in our young athletic population. From January 1986 to December 1995, 127 patients were treated for acute initial shoulder dislocation at the United States Military Academy. Of the 55 patients treated nonoperatively, 47 (85%) have had recurrence of instability. Seventy-two patients were treated operatively during three separate phases in the evolution of arthroscopic management at our institution. The initial phase (1986 to 1988) of operative treatment included either arthroscopic abrasion or staple repair. The low recurrence rate (2 of 9) was promising. In the operative technique for the second phase (1988 to 1991) transglenoid sutures were used. Of the 21 patients treated in this manner, 18 (86%) had no recurrent instability at last follow-up (average, 32 months). In the third phase (1991 to 1993), patients were treated with a bioabsorbable tack and interscalene anesthesia, and in the sitting position. Thus far, 39 of the latest 42 cadetathletes with acute initial anterior shoulder dislocations have had stabilization with this bioabsorbable cannulated fixation device. The average age was 19.5 years (range, 17 to 23 years). Follow-up averaged 22 months. There were no perioperative complications. Of these 39 patients, 35 (90%) have a stable shoulder and have returned to preinjury performance status. One of 2 patients with recurrent subluxation and 1 of 2 patients with a traumatic redislocation required an open Bankart repair. In young athletes known to have high recurrence rates with nonoperative treatment, acute arthroscopic stabilization appears to be an effective minimally invasive treatment option that favorably alters the natural history of shoulder instability.
在过去十年里，为改善年轻运动员群体肩部不稳定的自然病程，西点军校对急性初次肩关节脱位的关节镜稳定术进行了深入研究。1986年1月至1995年12月，美国军事学院有127例患者接受了急性初次肩关节脱位的治疗。在55例非手术治疗的患者中，47例（85%）出现了不稳定复发。在我们机构关节镜治疗发展的三个不同阶段，有72例患者接受了手术治疗。手术治疗的第一阶段（1986年至1988年）包括关节镜下磨削或钉合修复。低复发率（9例中的2例）很有前景。第二阶段（1988年至1991年）的手术技术采用了经关节盂缝线。以这种方式治疗的21例患者中，18例（86%）在最后一次随访时（平均32个月）没有复发性不稳定。在第三阶段（1991年至1993年），患者采用生物可吸收钉和肌间沟麻醉，并在坐位下进行治疗。到目前为止，最新的42例急性初次前肩关节脱位的军校学员运动员中，有39例通过这种生物可吸收空心固定装置实现了稳定。平均年龄为19.5岁（范围17至23岁）。平均随访22个月。没有围手术期并发症。在这39例患者中，35例（90%）肩部稳定，并恢复到受伤前的运动状态。2例复发性半脱位患者中的1例和2例创伤性再脱位患者中的1例需要进行开放性Bankart修复。对于已知非手术治疗复发率高的年轻运动员，急性关节镜稳定术似乎是一种有效的微创治疗选择，可有利地改变肩部不稳定的自然病程。
