运动员肩不稳术后重返运动的研究进展

Research Progress of Reactivation after Shoulder Instability

背景:前肩不稳定对年轻运动员来说是一种致残的情况,然而最佳的外科治疗仍然存在争议,传统上,前肩不稳定采用开放稳定治疗。近年来,关节镜下缝合锚钉固定Bankart修复损伤、Latarjet手术和开放稳定固定手术已成为公认的技术。目的:目前还没有系统的文献对关节镜下Bankart修复手术、Latarjet手术和开放稳定固定手术的恢复率进行比较。本文通过对运动员创伤性肩不稳定后发生复发性不稳定的研究,为了促使运动员尽快重返赛场,参考多篇文献进行分析研究。方法:本文重点研究肩关节稳定后的恢复情况,纳入标准为创伤性肩不稳定治疗后的运动恢复和临床结果,报告了初次关节镜下Bankart修复、Latarjet手术或开放稳定治疗后的重返运动率和临床结果。结果:研究显示,关节镜下Bankart修复、Latarjet手术、开放式修复等手术,各研究的患者人口学数据无显著差异。关节镜下Bankart修复术或Latarjet手术后,患者基本可恢复至损伤前的水平。不同研究中,任何水平的恢复情况和术后Rowe评分均无显著差异。术后复发性脱位发生率明显低于关节镜下Bankart修复或开放性稳定。结论:本研究显示,在关节镜下Bankart修复和Latarjet手术后,损伤前水平的恢复率比开放稳定手术高。尽管存在这种差异,接受治疗的所有运动员中,大部分的人回到了受伤前的运动水平,治疗组的其他结果指标也类似。因此,关节镜下Bankart修复术、Latarjet手术和开放性稳定手术仍然是治疗前肩不稳定运动员的良好选择。

Background:Shoulder instability is a disabling condition for young athletes;however, the best surgical treatment is still controversial. Traditionally, open stabilization treatment is used for anterior shoulder instability. In recent years, arthroscopic suture and anchor fixation for Bankart repair injuries, Latarjet surgery and open stabilization fixation surgery have become accepted technologies. Objective: Currently, there is no systematic literature to compare the recovery rate of Bankart repair surgery Latarjet and open stable fixation surgery under arthroscopy. In order to promote athletes to return to the track as soon as possible, statistical analysis is made by referring to multiple literatures. Methods: This paper focuses on the recovery of shoulder joint after stabilization.The inclusion criteria were motor recovery and clinical outcomes after treatment of traumatic shoulder instability, and the rate and clinical outcomes of re-exercise after Bankart suture anchor repair under initial arthroscopy, Latarjet surgery or open stable treatment were reported. Results:According to the study, there was no significant difference in patient demographic data of the Bankart repair, Latarjet surgery, open repair and other surgeries with suture anchors. After arthroscopic Bankart prosthesis or Latarjet surgery, there was a statistically significant difference in patients’ recovery to pre-injury levels. In different studies, there was no significant difference in recovery at any level or in postoperative Rowe scores. The incidence of recurrent dislocation after surgery was significantly lower than that of Bankart repair under arthroscopy or open and stable. Conclusion: This study showed that the recovery rate of the pre-injury level was higher after arthroscopic Bankart repair and Latarjet surgery than that of open and stable surgery.Despite the difference, most of the all athletes treated returned to their pre-injury activity levels, and other outcome indicators for the treatment group were similar.Therefore, arthroscopic Bankart repair, Latarjet surgery and open stabilization surgery are still good surgical options for athletes with anterior shoulder instability.