Pevny T, Hunter R E, Freeman J R
Orthopaedic Associates of Aspen & Glenwood, Aspen, Colorado 81611, USA.
Arthroscopy. 1998 Apr;14(3):289-94. doi: 10.1016/s0749-8063(98)70145-8.
During three consecutive ski seasons (1991 to 1994), 125 patients 40 years of age and older without previous shoulder injuries or surgery sustained a traumatic first-time anterior shoulder dislocation. At a minimum of 2 years' follow-up, patients were contacted to determine long-term outcome and to identify factors leading to prolonged morbidity or the need for surgical intervention. Fifty-two patients were available for interview. A modified Rowe shoulder score showed 32 excellent, nine good, eight fair, and three poor results. Eighteen (35%) rotator cuff tears were subsequently identified, with only 11 (61%) of these patients obtaining an excellent or good outcome (P = .011). Of the 11 patients with a fair or poor result, seven (64%) had a rotator cuff tear. Of the 12 patients with isolated cuff tears, 84% had an excellent or good result when treated surgically, compared with 50% when treated nonsurgically. Our findings indicate that recurrence is not a frequent complication of traumatic anterior shoulder dislocation in this age-group (4%). However, prolonged morbidity secondary to rotator cuff tear is more prevalent than in a younger population. We believe early diagnosis of rotator cuff pathology by either magnetic resonance imaging (MRI) or arthrogram with subsequent surgical repair can lead to faster restoration of function and a better outcome in these select individuals.
在连续三个滑雪季节（1991年至1994年）中，125名40岁及以上且既往无肩部损伤或手术史的患者首次发生外伤性前肩脱位。在至少2年的随访中，与患者取得联系以确定长期预后，并识别导致发病时间延长或需要手术干预的因素。52名患者可供访谈。改良的Rowe肩关节评分显示，结果为优的有32例，良的有9例，可的有8例，差的有3例。随后发现18例（35%）存在肩袖撕裂，其中只有11例（61%）患者获得了优或良的结果（P = 0.011）。在结果为可或差的11例患者中，7例（64%）存在肩袖撕裂。在12例孤立性肩袖撕裂患者中，手术治疗的84%获得了优或良的结果，而非手术治疗的这一比例为50%。我们的研究结果表明，在这个年龄组中，复发性外伤性前肩脱位并非常见并发症（4%）。然而，肩袖撕裂继发的发病时间延长比年轻人群更为普遍。我们认为，通过磁共振成像（MRI）或关节造影早期诊断肩袖病变，随后进行手术修复，可以使这些特定个体的功能恢复更快，预后更好。
