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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Bony Versus Soft Tissue Reconstruction for Anterior Shoulder Instability
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Bony Versus Soft Tissue Reconstruction for Anterior Shoulder Instability

机译：骨骼对软组织重建前肩不稳定

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Background: One complication of anteroinferior glenohumeral shoulder dislocation is a critical bone defect that requires surgical repair to prevent recurrent instability. However, controversy exists regarding the surgical management because both open and arthroscopic surgeries have respective advantages and disadvantages. Moreover, it is difficult to determine the patient’s preferred treatment, as factors that influence treatment choice include recurrence rates, morbidity of the procedures, and patient preferences. Hypothesis: Patients who have a higher probability of recurrent instability after arthroscopic surgery will select open surgery whereas patients with a lower probability of recurrent instability after arthroscopic surgery will favor arthroscopy. Study Design: Economic and decision analysis; Level of evidence, 2. Methods: A decision tree was constructed to model each hypothetical outcome after open or arthroscopic surgery for glenohumeral instability in patients with bone defects. A literature review was performed to determine the probability of occurrence for each node while utility values for each outcome were obtained via patient-administered surveys given to 50 patients without prior history of shoulder injury or dislocation. Fold-back analysis was then performed to show the optimal treatment strategy. Finally, sensitivity analysis established the thresholds at which open treatment becomes the optimal treatment. Results: The ultimate expected value—the objective evaluation of all potential outcomes after choosing either open or arthroscopic surgery—was found to be greater for arthroscopic surgery than for open surgery (87.17 vs 81.64), indicating it to be the preferred treatment. Results of sensitivity analysis indicated that open surgery becomes the preferred treatment when probability of recurrence after arthroscopic treatment is ≥23.8%, although varying the utility, defined as an aggregate patient preference for a particular outcome, has no effect on the model. When the rate of no complication after open surgery is 97.6%, open surgery becomes the patient’s preferred treatment. Conclusion: Arthroscopic surgery is an acceptable treatment if recurrent instability occurs consistently at ≤23.8%. This has important implications given the technical difficulty of successfully performing arthroscopic fixation to resolve recurrent anteroinferior glenohumeral dislocations associated with critical osseous defects. However, due to a lack of clinical outcomes studies, more research is needed to better predict the optimal operative treatment.
机译：背景：头发胶质肿块脱位的一种并发症是需要手术修复以防止反复稳定性的临界骨缺陷。然而，有关手术管理的争议存在，因为开放和关节镜手术既具有各自的优缺点。此外，难以确定患者的优选治疗，因为影响治疗选择的因素包括复发率，程序的发病率和患者偏好。假设：关节镜手术后具有更高概率较高概率的患者，将选择开放式手术，而关节镜手术后经常性不稳定概率较低的患者将有利于关节镜检查。研究设计：经济和决策分析;证据水平，2.方法：建立一个决策树以在骨缺损患者的胶质形状不稳定性的开放或关节镜手术后模拟每个假设结果。进行文献综述以确定每个节点的发生概率，而通过患者患者给予每次结果的效用值，没有给予50名没有肩部伤害或错位历史的患者。然后进行折叠分析以显示最佳治疗策略。最后，敏感性分析建立了开放治疗成为最佳治疗的阈值。结果：终极预期值 - 选择开放或关节镜手术后所有潜在结果的客观评价 - 对于关节镜手术而言，对开放手术（87.17 vs 81.64），表明它是优选的治疗。敏感性分析结果表明，当关节镜治疗后复发的概率≥23.8％的概率≥23.8％时，开放手术变为优选的处理，尽管不同的实用性，定义为特定结果的聚集患者偏好，对模型没有影响。开放手术后无复杂率为97.6％，开放式手术成为患者的首选治疗。结论：关节镜手术是一种可接受的治疗，如果经常性不稳定均匀地≤23.8％。鉴于成功进行关节镜固定的技术难题以解决与临界骨缺损相关的复发性前血管胶质形状脱位的技术难题具有重要意义。然而，由于缺乏临床结果研究，需要更多的研究来更好地预测最佳的手术治疗。

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