复发性肩关节前方不稳定的诊断与治疗

Diagnosis and treatment of recurrent anterior shoulder dislocation

复发性肩关节前方不稳定是我们在临床工作中经常能碰到的一类问题。目前,该病的发病机制、诊断方法以及治疗手段均有了极大的进展。基础研究方面,从明确盂肱韧带在肩关节不稳定发病中的重要意义发展到目前认为肩关节的稳定是由肩关节周围的主动、被动稳定结构的综合作用的结果。诊断方面,在传统的病史、查体及X线片等方法的基础上进一步引入了MRI、麻醉下查体以及关节镜检查等新的方法。关于该病的治疗,一方面切开手术治疗尤其是Bankart修补术已日益成熟并成为治疗的金标准;另一方面,关节镜下修补术由于其突出的优势在近来获得了迅速的发展,并逐步取得了与切开手术近似的效果。

Recurrent anterior shoulder instability is a common problem we have to deal with in clinic. With the progress in shoulder and elbow surgery, there have appeared many new concepts about the etiology, diagnosis and treatment of this disease. About 2 decades ago, people realized the important role of glenohumeral ligaments. Now we believe that the stability of the glenohumeral joint relies heavily on the congruent articulating surfaces and surrounding soft tissues that act as static and dynamic stabilizers. Many new methods, such as MRI, physical examination under anesthesia and arthroscopy, can help us diagnose the disease accurately. Moreover, substantial progress has been made in the treatment of anterior shoulder instability. Open Bankart repair has become the golden standard for the treatment. With the advance of techniques, however, arthroscopic stabilization of anterior shoulder instability can now achieve good results comparable with those of open surgery.