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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Glenoid Bone Loss in Posterior Shoulder Instability: Prevalence and Implications in Arthroscopic Treatment
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Glenoid Bone Loss in Posterior Shoulder Instability: Prevalence and Implications in Arthroscopic Treatment

机译：后肩关节不稳的Glenoid骨丢失：流行病学及在关节镜治疗中的意义

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Objectives: Glenoid bone loss is a well accepted risk factor for failure after arthroscopic stabilization of anterior glenohumeral instability. While less common than its anterior counterpart, posterior glenohumeral instability can be a significant source of disability in a young athletic population. It has been reported in as high as 10% of all glenohumeral instability cases. Bone loss in posterior instability, however, has been rarely discussed, and it is unknown whether this is commonly present, or clinically significant, in the treatment of posterior glenohumeral instability. Methods: A retrospective review was conducted at an active Military Treatment Facility (MTF) over a five-year period, between 1 Apr 2006 and 31 May 2011. Isolated, primary posterior instability cases which underwent arthroscopic posterior labral repair were identified. Preoperative imaging was available in all patients, and posterior glenoid bone loss was calculated using a standardized “perfect circle” technique often employed in the measurement of bone loss in anterior instability. All medical records were then reviewed to identify complications and reoperation rates from the primary repair. Patients were divided into two groups based on percentage bone loss. Outcomes were analyzed across all patients and within these groups. Results: There were 47 consecutive cases of primary, isolated posterior instability cases, with 44 males and 3 females. The average age at the time of surgery was 28.6 (range 20-47), 19 were documented to have returned to full duty. Posterior glenoid bone loss in excess of 10% was found in 15/47 (32%) of patients, while an additional 26% had no bone loss noted. Greater than 20% bone loss was noted in 2/47 (4.3%). The average across the cohort was 7.6% (range 0-21.5%). Bone loss was associated with younger age. Those with >10% loss had an average age of 25.6 years compared to 30.1 years in those with 10% were not associated with lower return to duty, higher complications (i.e. persistent symptoms), or increased return to the operating room. Those who returned to full active duty did not have a significantly decreased bone loss versus those who did not (6.5 vs 8.3%, p=0.17). Conclusion: Posterior instability accounts for up to 10% of all glenohumeral instability. It carries a more an insidious onset, and acute dislocations are not as commonly reported. While anterior glenoid bone loss is known to significantly affect patient outcomes for anterior glenohumeral instability, our data suggests posterior glenoid bone loss may not have as direct of a clinical correlation to patient outcomes.
机译：目的：关节镜稳定前盂肱骨不稳定性后，类固醇骨质丢失是导致失败的公认风险因素。尽管比以前的同伴少见，但后肱骨肱骨不稳可能是年轻运动人群致残的重要原因。据报道，在所有的肱骨肱骨不稳病例中高达10％。然而，关于后路不稳定的骨丢失很少被讨论，并且在后盂肱关节不稳定性的治疗中是否普遍存在或在临床上尚不清楚，这是未知的。方法：回顾性研究在2006年4月1日至2011年5月31日期间的一个现役军事治疗机构（MTF）进行了为期五年的研究。确定了经关节镜后唇修复的孤立性原发性后路不稳定病例。所有患者均可以进行术前影像检查，并使用标准化“完美圆”技术计算后盂盂骨丢失，该技术通常用于测量前路不稳定性的骨丢失。然后检查所有病历，以确认并发症和初次修复的再手术率。根据骨丢失百分比将患者分为两组。对所有患者以及这些组中的结果进行了分析。结果：原发性孤立性后路不稳定病例连续47例，男44例，女3例。手术时的平均年龄为28.6岁（20-47岁），据记录有19岁已恢复全职。在15/47（32％）的患者中发现后盂盂骨丢失超过10％，而另外26％的患者未发现骨丢失。在2/47（4.3％）中发现骨质流失超过20％。整个队列的平均值为7.6％（范围为0-21.5％）。骨丢失与年龄较小有关。损失> 10％的人的平均年龄为25.6岁，而10％的人的平均年龄为30.1岁，这与较低的任务返回率，较高的并发症（即持续症状）或增加的返回手术室无关。重返现役的人的骨丢失没有显着减少（6.5 vs 8.3％，p = 0.17）。结论：后路不稳定占所有盂肱肱骨不稳定的10％。它起病隐匿，急性脱位的报道不多。尽管已知前盂盂骨丢失会严重影响前盂肱骨不稳的患者预后，但我们的数据表明后盂盂骨丢失可能与患者预后没有直接的临床相关性。

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