The purpose of this review article is to discuss the clinical spectrum of recurrent traumatic anterior shoulder instability with the current concepts and controversies at the scientific level. Because of increasing pa...The purpose of this review article is to discuss the clinical spectrum of recurrent traumatic anterior shoulder instability with the current concepts and controversies at the scientific level. Because of increasing participation of people from any age group of the population in sports activities, health care professionals dealing with the care of trauma patients must have a thorough understanding of the anatomy, patho-physiology, risk factors, and management of anterior shoulder instability. The risk factors for recurrent shoulder dislocation are young age, participation in high demand contact sports activities, presence of Hill-Sachs or osseous Bankart lesion, previous history of ipsilateral traumatic dislocation, ipsilateral rotator cuff or deltoid muscle insufficiency, and underlying ligamentous laxity. Achieving the best result for any particular patient depends onthe procedure that allows observation of the joint surfaces, provides the anatomical repair, maintains range of motion, and also can be applied with low rates of complications and recurrence. Although various surgical techniques have been described, a consensus does not exist and thus, orthopedic surgeons should follow and try to improve the current evidence-based treatment modalities for the patients.展开更多
BACKGROUND Recurrent anterior shoulder instability is a common traumatic injury,the main clinical manifestation of which is recurrent anteroinferior dislocation of the humeral head.The current follow-up study showed t...BACKGROUND Recurrent anterior shoulder instability is a common traumatic injury,the main clinical manifestation of which is recurrent anteroinferior dislocation of the humeral head.The current follow-up study showed that the effect of arthroscopic Bankart repair is unreliable.AIM To evaluate the clinical efficacy of arthroscopy with subscapularis upper one-third tenodesis for treatment of anterior shoulder instability,and to develop a method to further improve anterior stability and reduce the recurrence rate.METHODS Between January 2015 and December 2018,male patients with recurrent anterior shoulder instability were selected.One hundred and twenty patients had a glenoid defect<20%and 80 patients had a glenoid defect>20%.The average age was 25 years(range,18–45 years).Patients with a glenoid defect<20%underwent arthroscopic Bankart repair with a subscapularis upper one-third tenodesis.The patients with a glenoid defect>20%underwent an arthroscopic iliac crest bone autograft with a subscapularis upper one-third tenodesis.All patients were assessed with Rowe and Constant scores.RESULTS The average shoulder forward flexion angle was 163.6°±8.3°and 171.8°±3.6°preoperatively and at the last follow-up evaluation,respectively.The average external rotation angle when abduction was 90°was 68.4°±13.6°and 88.5°±6.2°preoperatively and at the last follow-up evaluation,respectively.The mean Rowe scores preoperatively and at the last follow-up evaluation were 32.6±3.2 and 95.2±2.2,respectively(P<0.05).The mean Constant scores preoperatively and at the last follow-up evaluation were 75.4±3.5 and 95.8±3.3,respectively(P<0.05).No postoperative dislocations were recorded by the end of the follow-up period.CONCLUSION Arthroscopy with subscapularis upper one-third tenodesis was effective for treatment of recurrent anterior shoulder instability independent of the size of the glenoid bone defect,enhanced anterior stability of the shoulder,and did not affect postoperative range of motion of the affected limb.展开更多
目的观察关节镜下对V型从前到后上盂唇损伤(superior labral anterior to posterior,SLAP)的复发性肩关节前脱位修复的临床疗效。方法收集我单位2008年3月-2010年12月V型SLAP损伤患者16例,选取同期单纯Bankart损伤病例16例作为对照组。...目的观察关节镜下对V型从前到后上盂唇损伤(superior labral anterior to posterior,SLAP)的复发性肩关节前脱位修复的临床疗效。方法收集我单位2008年3月-2010年12月V型SLAP损伤患者16例,选取同期单纯Bankart损伤病例16例作为对照组。在关节镜下采用可吸收带线锚钉修复盂唇。采用视觉模拟评分(visual analogue scale,VAS)评价疼痛,美国肩肘外科协会(American Shoulder and Elbow Surgeons,ASES)评分系统和Rowe肩关节评分系统评价关节功能。结果两组患者术后VAS评分、ASES评分和Rowe评分均优于术前(P<0.05),没有脱位复发。两组患者术后结果的差异无统计学意义(P>0.05)。结论对V型SLAP损伤的复发性肩关节前脱位,采用可吸收带线锚钉进行修复可获得良好的临床效果。展开更多
目的评估肩关节镜下锚钉内固定术治疗复发性肩关节前脱位的临床疗效,并探讨锚钉固定位置、跨度对临床疗效的影响。方法2013年1月至2016年6月,前瞻性纳入47例复发性肩关节前脱位病人,关节镜下使用3枚Lupine锚钉固定撕裂的盂唇。术后第2...目的评估肩关节镜下锚钉内固定术治疗复发性肩关节前脱位的临床疗效,并探讨锚钉固定位置、跨度对临床疗效的影响。方法2013年1月至2016年6月,前瞻性纳入47例复发性肩关节前脱位病人,关节镜下使用3枚Lupine锚钉固定撕裂的盂唇。术后第2日常规复查肩关节三维CT,以表盘上的时间刻度描述锚钉位点及跨度。采用数字分级法(numerical rating scale, NRS)评估病人的疼痛程度;使用美国肩肘外科医师学会(American Shoulder and Elbow Surgeons, ASES)评分及Constant-Murley评分评估手术前后关节功能。使用丹麦健康与医疗管理局(Danish Health and Medicine Authority)满意度评分表评估病人满意度。分析锚钉固定位置、跨度等因素与Constant-Murley评分的关系。结果47例病人术后未出现明显并发症,术后的NRS评分、ASES评分、Constant-Murley评分均较术前显著改善,差异均有统计学意义(P均<0.05)。病人满意度评分为(8.2±1.3)分。锚钉跨度越大,Constant-Murley评分越低(F=21.714,P<0.001);锚定位置越高(越接近12点钟位置),Constant-Murley评分越低(F=13.752,P=0.006)。结论锚钉固定前下盂唇可有效改善病人肩关节功能,有利于肩关节稳定性重建,且锚钉固定的位置及跨度与肩关节术后稳定性相关。展开更多
文摘The purpose of this review article is to discuss the clinical spectrum of recurrent traumatic anterior shoulder instability with the current concepts and controversies at the scientific level. Because of increasing participation of people from any age group of the population in sports activities, health care professionals dealing with the care of trauma patients must have a thorough understanding of the anatomy, patho-physiology, risk factors, and management of anterior shoulder instability. The risk factors for recurrent shoulder dislocation are young age, participation in high demand contact sports activities, presence of Hill-Sachs or osseous Bankart lesion, previous history of ipsilateral traumatic dislocation, ipsilateral rotator cuff or deltoid muscle insufficiency, and underlying ligamentous laxity. Achieving the best result for any particular patient depends onthe procedure that allows observation of the joint surfaces, provides the anatomical repair, maintains range of motion, and also can be applied with low rates of complications and recurrence. Although various surgical techniques have been described, a consensus does not exist and thus, orthopedic surgeons should follow and try to improve the current evidence-based treatment modalities for the patients.
文摘BACKGROUND Recurrent anterior shoulder instability is a common traumatic injury,the main clinical manifestation of which is recurrent anteroinferior dislocation of the humeral head.The current follow-up study showed that the effect of arthroscopic Bankart repair is unreliable.AIM To evaluate the clinical efficacy of arthroscopy with subscapularis upper one-third tenodesis for treatment of anterior shoulder instability,and to develop a method to further improve anterior stability and reduce the recurrence rate.METHODS Between January 2015 and December 2018,male patients with recurrent anterior shoulder instability were selected.One hundred and twenty patients had a glenoid defect<20%and 80 patients had a glenoid defect>20%.The average age was 25 years(range,18–45 years).Patients with a glenoid defect<20%underwent arthroscopic Bankart repair with a subscapularis upper one-third tenodesis.The patients with a glenoid defect>20%underwent an arthroscopic iliac crest bone autograft with a subscapularis upper one-third tenodesis.All patients were assessed with Rowe and Constant scores.RESULTS The average shoulder forward flexion angle was 163.6°±8.3°and 171.8°±3.6°preoperatively and at the last follow-up evaluation,respectively.The average external rotation angle when abduction was 90°was 68.4°±13.6°and 88.5°±6.2°preoperatively and at the last follow-up evaluation,respectively.The mean Rowe scores preoperatively and at the last follow-up evaluation were 32.6±3.2 and 95.2±2.2,respectively(P<0.05).The mean Constant scores preoperatively and at the last follow-up evaluation were 75.4±3.5 and 95.8±3.3,respectively(P<0.05).No postoperative dislocations were recorded by the end of the follow-up period.CONCLUSION Arthroscopy with subscapularis upper one-third tenodesis was effective for treatment of recurrent anterior shoulder instability independent of the size of the glenoid bone defect,enhanced anterior stability of the shoulder,and did not affect postoperative range of motion of the affected limb.
文摘目的评估肩关节镜下锚钉内固定术治疗复发性肩关节前脱位的临床疗效,并探讨锚钉固定位置、跨度对临床疗效的影响。方法2013年1月至2016年6月,前瞻性纳入47例复发性肩关节前脱位病人,关节镜下使用3枚Lupine锚钉固定撕裂的盂唇。术后第2日常规复查肩关节三维CT,以表盘上的时间刻度描述锚钉位点及跨度。采用数字分级法(numerical rating scale, NRS)评估病人的疼痛程度;使用美国肩肘外科医师学会(American Shoulder and Elbow Surgeons, ASES)评分及Constant-Murley评分评估手术前后关节功能。使用丹麦健康与医疗管理局(Danish Health and Medicine Authority)满意度评分表评估病人满意度。分析锚钉固定位置、跨度等因素与Constant-Murley评分的关系。结果47例病人术后未出现明显并发症,术后的NRS评分、ASES评分、Constant-Murley评分均较术前显著改善,差异均有统计学意义(P均<0.05)。病人满意度评分为(8.2±1.3)分。锚钉跨度越大,Constant-Murley评分越低(F=21.714,P<0.001);锚定位置越高(越接近12点钟位置),Constant-Murley评分越低(F=13.752,P=0.006)。结论锚钉固定前下盂唇可有效改善病人肩关节功能,有利于肩关节稳定性重建,且锚钉固定的位置及跨度与肩关节术后稳定性相关。
