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Current Concepts in the Measurement of Glenohumeral Bone Loss. 肱骨盂骨丢失测量的最新概念。
IF 4.1 2区 医学 Q1 Medicine Pub Date : 2023-09-01 DOI: 10.1007/s12178-023-09852-0
Ryan R Thacher, Julia S Retzky, Mihir S Dekhne, Yousi A Oquendo, Harry G Greditzer

Purpose: The extent of glenohumeral bone loss seen in anterior shoulder dislocations plays a major role in guiding surgical management of these patients. The need for accurate and reliable preoperative assessment of bone loss on imaging studies is therefore of paramount importance to orthopedic surgeons. This article will focus on the tools that are available to clinicians for quantifying glenoid bone loss with a focus on emerging trends and research in order to describe current practices.

Recent findings: Recent evidence supports the use of 3D CT as the most optimal method for quantifying bone loss on the glenoid and humerus. New trends in the use of 3D and ZTE MRI represent exciting alternatives to CT imaging, although they are not widely used and require further investigation. Contemporary thinking surrounding the glenoid track concept and the symbiotic relationship between glenoid and humeral bone loss on shoulder stability has transformed our understanding of these lesions and has inspired a new focus of study for radiologists and orthopedist alike. Although a number of different advanced imaging modalities are utilized to detect and quantify glenohumeral bone loss in practice, the current literature supports 3D CT imaging to provide the most reliable and accurate assessments. The emergence of the glenoid track concept for glenoid and humeral head bone loss has inspired a new area of study for researchers that presents exciting opportunities for the development of a deeper understanding of glenohumeral instability in the future. Ultimately, however, the heterogeneity of literature, which speaks to the diverse practices that exist across the world, limits any firm conclusions from being drawn.

目的:观察肩关节前脱位患者肱骨盂骨丢失的程度对指导手术治疗具有重要意义。因此,对骨科医生来说,在影像学研究中对骨质流失进行准确可靠的术前评估是至关重要的。本文将重点介绍临床医生可用于量化盂骨丢失的工具,重点是新兴趋势和研究,以描述当前的实践。最近的发现:最近的证据支持使用3D CT作为量化关节盂和肱骨骨丢失的最佳方法。3D和中兴核磁共振成像的新趋势代表了CT成像的令人兴奋的替代方案,尽管它们尚未被广泛使用,需要进一步的研究。围绕肩关节轨迹概念的当代思考以及肩关节和肱骨骨丢失对肩部稳定性的共生关系改变了我们对这些病变的理解,并激发了放射科医生和骨科医生的新研究重点。尽管在实践中使用了许多不同的先进成像方式来检测和量化盂肱骨丢失,但目前的文献支持3D CT成像提供最可靠和准确的评估。肩关节和肱骨头骨丢失的肩关节径迹概念的出现为研究人员提供了一个新的研究领域,为未来对肩关节不稳定的深入了解提供了令人兴奋的机会。然而,从根本上说,文学的异质性(反映了世界各地存在的各种实践)限制了得出任何确定的结论。
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引用次数: 0
Fracture Dislocations of the Glenohumeral Joint. 盂肱关节骨折脱位。
IF 4.1 2区 医学 Q1 Medicine Pub Date : 2023-08-01 DOI: 10.1007/s12178-023-09846-y
Joseph T Labrum, Nicolas P Kuttner, Yousif Atwan, Joaquin Sanchez-Sotelo, Jonathan D Barlow

Purpose of review: Proximal humerus fracture dislocations typically result from high-energy mechanisms and carry specific risks, technical challenges, and management considerations. It is vital for treating surgeons to understand the various indications, procedures, and complications involved with their treatment.

Recent findings: While these injuries are relatively rare in comparison with other categories of proximal humerus fractures, fracture dislocations of the proximal humerus require treating surgeons to consider patient age, activity level, injury pattern, and occasionally intra-operative findings to select the ideal treatment strategy for each injury. Proximal humerus fracture dislocations are complex injuries that require special considerations. This review summarizes recent literature regarding the evaluation and management of these injuries as well as the indications and surgical techniques for each treatment strategy. Thorough pre-operative patient evaluation and shared decision-making should be employed in all cases. While nonoperative management is uncommonly considered, open reduction and internal fixation (ORIF), hemiarthroplasty, and reverse total shoulder replacement are at the surgeon's disposal, each with their own indications and complication profile.

综述目的:肱骨近端骨折脱位通常由高能机制引起,具有特定的风险、技术挑战和管理方面的考虑。对于治疗外科医生来说,了解各种适应症、手术程序和治疗过程中的并发症是至关重要的。最近的研究结果:虽然与其他类型的肱骨近端骨折相比,这些损伤相对罕见,但肱骨近端骨折脱位需要治疗外科医生考虑患者的年龄、活动水平、损伤模式,以及偶尔的术中发现,以选择每种损伤的理想治疗策略。肱骨近端骨折脱位是需要特殊考虑的复杂损伤。这篇综述总结了最近关于这些损伤的评估和管理的文献,以及每种治疗策略的指征和手术技术。在所有病例中都应采用彻底的术前患者评估和共同决策。虽然非手术治疗很少被考虑,但外科医生可以选择切开复位内固定(ORIF)、半关节置换术和反向全肩关节置换术,每种方法都有自己的适应症和并发症。
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引用次数: 0
Return to Sport After Hip and Knee Arthroplasty: Counseling the Patient on Resuming an Active Lifestyle. 髋关节和膝关节置换术后重返运动:建议患者恢复积极的生活方式。
IF 4.1 2区 医学 Q1 Medicine Pub Date : 2023-08-01 DOI: 10.1007/s12178-023-09839-x
Armin Arshi, Andrew J Hughes, Joseph X Robin, Javad Parvizi, Yale A Fillingham

Purposeof review: The purpose of this review is to summarize the available literature on the epidemiology, biomechanics, clinical outcomes, and complications of return to sport after TJA, as well as provide guidelines for patients' safe return to athletic activity.

Recent findings: As volume and indications for total joint arthroplasty (TJA) expand, arthroplasty candidates today are demographically younger, more physically active, and have higher expectations for postoperative function. Many TJA patients wish to resume sports activity that may theoretically place their reconstruction under more biomechanical stress and risk for early wear or failure. Recommendations for postoperative patient activity following TJA have historically largely been surgeon-dependent and in the context of evolving prosthetic design and surgical techniques. We endorse a three-tiered framework for return to sporting activities: (1) low-impact sports are generally recommended, (2) intermediate-impact sports are generally recommended with experience, and (3) high-impact sports are generally not recommended though activity-specific joint decisions between patient and surgeon can be made.

综述目的:本综述的目的是总结TJA术后恢复运动的流行病学、生物力学、临床结局和并发症方面的现有文献,为患者安全恢复运动提供指导。最近的发现:随着全关节置换术(TJA)的容量和适应症的扩大,关节置换术的候选人在人口统计学上更年轻,更活跃,对术后功能有更高的期望。许多TJA患者希望恢复体育活动,这可能在理论上使他们的重建承受更多的生物力学压力和早期磨损或失败的风险。TJA术后患者活动的建议在历史上很大程度上取决于外科医生,并且在不断发展的假体设计和手术技术的背景下。我们支持一个三层框架,用于恢复体育活动:(1)通常建议进行低强度运动,(2)通常建议进行有经验的中等强度运动,(3)通常不建议进行高强度运动,尽管可以由患者和外科医生共同决定具体的活动。
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引用次数: 1
Management of Glenoid Bone Loss in Primary Reverse Total Shoulder Arthroplasty. 初次逆行全肩关节置换术中肩关节骨丢失的处理。
IF 4.1 2区 医学 Q1 Medicine Pub Date : 2023-08-01 DOI: 10.1007/s12178-023-09845-z
Nabil Mehta, Gregory P Nicholson

Purpose of review: Glenoid bone loss presents distinct challenges in reverse total shoulder arthroplasty (rTSA) which, if unaddressed, can cause complications including poor outcomes and early implant failure. The purpose of this review is to discuss the etiology, evaluation, and management strategies of glenoid bone loss in primary rTSA.

Recent findings: Three-dimensional computed tomography (3D CT) imaging and preoperative planning software have revolutionized the understanding of complex glenoid deformity and wear patterns from bone loss. With this knowledge, a detailed preoperative plan can be created and implemented for a more optimal management strategy. When appropriately indicated, deformity correction techniques with biologic or metal augmentation are successful in addressing the glenoid bone deficiency, creating optimal implant position, and thus providing stable baseplate fixation and improving outcomes. Thorough evaluation and characterization of the degree of glenoid deformity with 3D CT imaging is necessary prior to treatment with rTSA. Eccentric reaming, bone grafting, and augmented glenoid components have shown promising results in correcting glenoid deformity due to bone loss, but long-term outcomes are currently unknown.

回顾目的:肩关节盂骨丢失是逆行全肩关节置换术(rTSA)中明显的挑战,如果不加以解决,可能导致并发症,包括预后不良和早期植入失败。本综述的目的是讨论原发性rTSA中盂骨丢失的病因、评估和管理策略。最近发现:三维计算机断层扫描(3D CT)成像和术前计划软件已经彻底改变了对复杂的肩关节畸形和骨质流失造成的磨损模式的理解。有了这些知识,就可以制定详细的术前计划,并实施更优化的管理策略。在适当的情况下,生物或金属隆胸的畸形矫正技术可以成功地解决关节盂骨缺损,创造最佳的植入物位置,从而提供稳定的底板固定和改善预后。在rTSA治疗之前,有必要通过3D CT成像对关节盂畸形程度进行全面评估和表征。偏心扩孔、植骨和增强盂骨假体在纠正骨质丢失引起的盂骨畸形方面显示出有希望的结果,但长期结果目前尚不清楚。
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引用次数: 0
Preventing and Treating Infection in Reverse Total Shoulder Arthroplasty. 逆向全肩关节置换术中感染的预防与治疗。
IF 4.1 2区 医学 Q1 Medicine Pub Date : 2023-08-01 DOI: 10.1007/s12178-023-09843-1
Alexander R Markes, Joseph Bigham, C Benjamin Ma, Jaicharan J Iyengar, Brian T Feeley

Purpose of review: Periprosthetic infection after shoulder arthroplasty is relatively uncommon though associated with severe long-term morbidity when encountered. The purpose of the review is to summarize the recent literature regarding the definition, clinical evaluation, prevention, and management of prosthetic joint infection after reverse shoulder arthroplasty.

Recent findings: The landmark report generated at the 2018 International Consensus Meeting on Musculoskeletal Infection has provided a framework for diagnosis, prevention, and management of periprosthetic infections after shoulder arthroplasty. Shoulder specific literature with validated interventions to reduce prosthetic joint infection is limited; however existing literature from retrospective studies and from total hip and knee arthroplasty allows us to make relative guidelines. One and two-stage revisions seem to demonstrate similar outcomes; however, no controlled comparative studies exist limiting the ability to make definitive recommendations between the two options. We report on recent literature regarding the current diagnostic, preventative, and treatment options for periprosthetic infection after shoulder arthroplasty. Much of the literature does not distinguish between anatomic and reverse shoulder arthroplasty, and further high-level shoulder specific studies are needed to answer questions generated from this review.

综述目的:肩关节置换术后假体周围感染相对不常见,但一旦遇到会导致严重的长期发病率。本综述的目的是总结关于肩关节置换术后假体关节感染的定义、临床评价、预防和处理的最新文献。最新发现:2018年国际肌肉骨骼感染共识会议上产生的具有里程碑意义的报告为肩关节置换术后假体周围感染的诊断、预防和管理提供了框架。肩关节特异性文献与有效干预措施减少假体关节感染是有限的;然而,来自回顾性研究和全髋关节和膝关节置换术的现有文献允许我们制定相关指南。一阶段和两阶段的修订似乎显示出类似的结果;然而,没有对照比较研究限制了在这两种选择之间做出明确建议的能力。我们报告了最近关于肩关节置换术后假体周围感染的诊断、预防和治疗选择的文献。许多文献没有区分解剖肩关节置换术和反向肩关节置换术,需要进一步的高水平肩部特异性研究来回答本综述中产生的问题。
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引用次数: 0
Quadriceps Dysfunction Following Joint Preservation Surgery: A Review of the Pathophysiologic Basis and Mitigation Strategies. 关节保留手术后的股四头肌功能障碍:病理生理学基础和缓解策略综述。
IF 2.9 2区 医学 Q1 ORTHOPEDICS Pub Date : 2023-08-01 Epub Date: 2023-05-27 DOI: 10.1007/s12178-023-09844-0
Daniel J Cognetti, Thomas B Lynch, Elizabeth Rich, Asheesh Bedi, Aman Dhawan, Andrew J Sheean

Purpose of review: To characterize quadriceps muscle dysfunction associated with knee joint preservation surgery, with a focus on its pathophysiology and promising approaches to mitigate its impact on clinical outcomes.

Recent findings: Quadriceps dysfunction (QD) associated with knee joint preservation surgery results from a complex interplay of signaling, related to changes within the joint and from those involving the overlying muscular envelope. Despite intensive rehabilitation regimens, QD may persist for many months postoperatively and negatively impact clinical outcomes associated with various surgical procedures. These facts underscore the need for continued investigation into the potential detrimental effects of regional anesthetic and intraoperative tourniquet use on postoperative quadriceps function, with an outward focus on innovation within the field of postoperative rehabilitation. Neuromuscular stimulation, nutritional supplementation, cryotherapy, blood flow restriction (BFR), and open-chain exercises are all potential additions to postoperative regimens. There is compelling literature to suggest that these modalities are efficacious and may diminish the magnitude and duration of postoperative QD. A clear understanding of QD, with respect to its pathophysiology, should guide perioperative treatment and rehabilitation strategies and influence ongoing rehabilitation-based research and innovation. Moreover, clinicians must appreciate the magnitude of QD's effect on diminished clinical outcomes, risk for re-injury and patients' ability (or inability) to return to pre-injury level of activity following knee joint preservation procedures.

综述的目的:描述与膝关节保留手术相关的股四头肌功能障碍的特征,重点关注其病理生理学以及减轻其对临床结果影响的可行方法:最近的研究结果:与膝关节保留手术相关的股四头肌功能障碍(QD)是由一系列复杂的信号相互作用引起的,这些信号与关节内部的变化以及涉及上层肌肉包膜的变化有关。尽管进行了强化康复治疗,但 QD 仍可能在术后持续数月,并对各种外科手术的临床疗效产生负面影响。这些事实突出表明,有必要继续研究区域麻醉和术中止血带的使用对术后股四头肌功能的潜在不利影响,并将重点放在术后康复领域的创新上。神经肌肉刺激、营养补充、冷冻疗法、血流限制(BFR)和开链运动都是术后康复疗法的潜在补充。有令人信服的文献表明,这些方法都很有效,可以减少术后 QD 的程度和持续时间。清楚地了解 QD 的病理生理学,应能指导围手术期治疗和康复策略,并影响以康复为基础的持续研究和创新。此外,临床医生还必须了解 QD 对临床疗效的影响程度、再次受伤的风险以及患者在膝关节保留手术后恢复到受伤前活动水平的能力(或无法恢复到受伤前活动水平)。
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引用次数: 0
The Lateral Meniscus Oblique Radial Tear (LMORT). 外侧半月板倾斜径向撕裂(LMORT)。
IF 4.1 2区 医学 Q1 Medicine Pub Date : 2023-07-01 DOI: 10.1007/s12178-023-09835-1
Adam V Daniel, Aaron J Krych, Patrick A Smith

Purpose of review: The lateral meniscus oblique radial tear (LMORT) of the posterior horn is a relatively new term for one of the more common types of lateral meniscal tears found in patients with acute anterior cruciate ligament (ACL) injuries. Given the importance of anatomical reduction and preservation of the lateral meniscus to maintain normal knee stability and slow the progression of early-onset osteoarthritis, LMORT classification and treatment guidelines have been formulated. This article provides a review of the prevalence, classification, biomechanics, surgical repair techniques, and outcomes related to LMORT injuries.

Recent findings: Current research demonstrates favorable clinical results when LMORTs are surgically treated based on recent evidence. Biomechanically, repair of the higher grade 3 and 4 LMORT lesions have led to comparable results when compared to an intact lateral meniscus, and superior results when compared to partial meniscectomy and untreated tears. Ongoing research is aimed to determine the difference between LMORT repairs compared to intact lateral menisci at the time of ACL surgery regarding comparable patient outcomes. LMORT lesions are common tears of the lateral meniscus that should be treated surgically based on tear type at the time of ACL surgery. The benefit of doing so has already been demonstrated biomechanically.

回顾目的:后角外侧半月板斜向径向撕裂(LMORT)是一个相对较新的术语,是急性前交叉韧带(ACL)损伤患者中更常见的外侧半月板撕裂之一。鉴于解剖复位和保留外侧半月板对维持正常膝关节稳定性和减缓早发性骨关节炎进展的重要性,LMORT的分类和治疗指南已被制定。本文综述了LMORT损伤的发病率、分类、生物力学、手术修复技术和预后。最近的发现:根据最近的证据,目前的研究表明,手术治疗LMORTs有良好的临床效果。生物力学方面,与完整外侧半月板相比,修复较高级别3级和4级LMORT病变的结果相当,与半月板部分切除术和未经治疗的撕裂相比,效果更好。正在进行的研究旨在确定LMORT修复与完整外侧半月板在ACL手术时的差异,并比较患者的预后。LMORT病变是外侧半月板常见的撕裂,在ACL手术时应根据撕裂类型进行手术治疗。这样做的好处已经在生物力学上得到了证明。
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引用次数: 0
Approaches to Septic Arthritis of the Knee Post Anterior Cruciate Ligament Reconstruction. 前交叉韧带重建后脓毒性膝关节炎的治疗方法。
IF 4.1 2区 医学 Q1 Medicine Pub Date : 2023-07-01 DOI: 10.1007/s12178-023-09841-3
Oladimeji Ranti Babalola, Adebukola Adedoyin Babalola, Kehinde Adesola Alatishe

Purpose of review: Septic arthritis of the knee following anterior cruciate ligament reconstruction is a rare but potentially deleterious complication. The main approach to the management of this potentially devastating complication in recent years has involved a more aggressive attempt at preventing graft contamination during surgery with the adoption of the pre-soaking of the graft in broad-spectrum antibiotic solution, and early and adequate treatment of established cases of knee sepsis, with or without retention of the graft. However, what constitutes an early and adequate initial treatment may be a challenging decision for the surgeon to make in certain instances.

Recent findings: Graft pre-soaking in vancomycin has been noted to significantly reduce the incidence of septic arthritis of the knee following anterior cruciate ligament reconstruction. Other studies have recorded similar satisfactory results with graft pre-soaking in gentamycin. In established cases of infection, irrigation and debridement with either graft retention or graft excision with delayed re-construction of the anterior cruciate ligament have both given satisfactory results in well-selected patients. Septic arthritis of the knee following anterior cruciate ligament reconstruction can be prevented by careful patient selection, use of prophylactic antibiotics, strict asepsis during surgery, and graft pre-soaking in antibiotic solution. The choice of antibiotic solution for graft pre-soaking is influenced by the surgeon's preference, tissue penetrance, effect on graft tensile strength, local bio-gram of the micro-organisms, and the sensitivity pattern. The treatment option in established cases would depend on the stage of infection, state of the graft, and the extent of bony involvement.

回顾目的:前交叉韧带重建后的脓毒性膝关节炎是一种罕见但潜在有害的并发症。近年来,治疗这种潜在的破坏性并发症的主要方法包括在手术中采用广谱抗生素溶液预浸泡移植物,更积极地尝试防止移植物污染,并对确定的膝关节败血症病例进行早期和充分的治疗,无论移植物是否保留。然而,对于外科医生来说,在某些情况下,早期和适当的初始治疗可能是一个具有挑战性的决定。最近的研究发现:移植物预先浸泡在万古霉素中可以显著降低前交叉韧带重建后脓毒性膝关节炎的发生率。其他研究也记录了用庆大霉素预浸泡移植物的类似满意结果。在确定的感染病例中,在精心挑选的患者中,无论是保留移植物还是切除移植物并延迟重建前交叉韧带,冲洗和清创都能获得满意的结果。通过仔细选择患者,使用预防性抗生素,术中严格无菌,并在抗生素溶液中预先浸泡移植物,可以预防前交叉韧带重建后的脓毒性膝关节炎。移植物预浸泡的抗生素溶液的选择受外科医生的偏好、组织外显率、对移植物抗拉强度的影响、微生物的局部生物特征和敏感性模式的影响。确定病例的治疗方案取决于感染的阶段、移植物的状态和骨受累的程度。
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引用次数: 0
Patellofemoral Instability in the Pediatric Population. 小儿髌骨股骨不稳症
IF 2.9 2区 医学 Q1 ORTHOPEDICS Pub Date : 2023-07-01 Epub Date: 2023-04-18 DOI: 10.1007/s12178-023-09836-0
Prushoth Vivekanantha, Dan Cohen, Devin Peterson, Darren de Sa

Purpose of review: This review focuses on the etiology, diagnosis, and management of patellar instability in pediatric patients.

Recent findings: Radiological outcomes such as tibial-tubercle to trochlear groove (TT-TG) distance used in diagnosis are subject to factors of influence such as femoral anteversion and knee flexion angle, and new measure such as tibial-tubercle to posterior cruciate ligament distance as well as TT-TG/trochlear width (TT-TG/TW) are under investigation. To prevent recurrent instability, surgical intervention for acute patellar dislocations may be advantageous compared to conservative management. Patellar instability is a common pathology found in pediatric cohorts. Diagnosis can be performed via a combination of history, physical examination maneuvers, and radiological risk factors such as patella alta, patellar tilt, trochlear dysplasia, and elevated TT-TG distances. Current literature advocates the usage of additional radiological measures to TT-TG such as TT-TG/TW, especially as TT-TG varies with age in younger patients. Recent literature potentially suggests the utilization of surgical procedures such as MPFL reconstruction or repair for acute dislocations in the hope of preventing recurrent instability. Special indications for pediatric patients include osteochondral fracture identification to help prevent patellofemoral osteoarthritis. A comprehensive workup and understanding of current literature can aid clinicians in aiming to prevent recurrent patellar dislocation in pediatric patients.

综述目的:本综述重点关注儿童患者髌骨不稳的病因、诊断和处理:最新研究结果:用于诊断的胫骨-髌骨至喙突沟(TT-TG)距离等放射学结果受股骨内翻和膝关节屈曲角度等因素的影响,而胫骨-髌骨至后交叉韧带距离以及TT-TG/喙突宽度(TT-TG/TW)等新的测量方法正在研究中。与保守治疗相比,手术治疗急性髌骨脱位可能更有利于预防复发性不稳定。髌骨不稳是儿科常见的病理现象。可通过综合病史、体格检查手法和放射学风险因素(如髌骨突出、髌骨倾斜、蹄铁发育不良和TT-TG距离升高)进行诊断。目前的文献主张在TT-TG基础上使用额外的放射学测量方法,如TT-TG/TW,尤其是年轻患者的TT-TG会随年龄变化。最近的文献可能建议对急性脱位采用手术治疗,如 MPFL 重建或修复,以防止复发性不稳定。儿童患者的特殊适应症包括骨软骨骨折鉴定,以帮助预防髌骨骨关节炎。全面的检查和对当前文献的了解有助于临床医生预防儿童患者复发性髌骨脱位。
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引用次数: 0
Pediatric and Adolescent Shoulder Instability. 儿童和青少年肩部不稳定。
IF 4.1 2区 医学 Q1 Medicine Pub Date : 2023-07-01 DOI: 10.1007/s12178-023-09837-z
Jeffrey Kay, Benton E Heyworth, Matthew D Milewski, Dennis E Kramer

Purpose of review: Traumatic and atraumatic shoulder instability is common in pediatric and adolescent patients. It is well-established that young patients with anterior shoulder dislocation are at high risk of recurrent instability. This review assesses the current literature pertaining to management of both anterior instability and MDI in the pediatric and adolescent populations.

Recent findings: Current research suggests that pediatric and adolescent patients with shoulder instability have excellent outcomes following arthroscopic Bankart repair; however, higher rates of recurrent instability requiring revision surgical management have been identified in patients with more than one dislocation episode pre-operatively, those with Hill-Sachs lesions and those under age 16. The addition of the remplissage procedure to an arthroscopic Bankart repair may be useful in preventing recurrent instability for patients with large Hill-Sachs lesions. Open procedures with bony glenoid augmentation may be indicated in patients with significant glenoid bone loss, or those who have failed primary surgical management, with promising outcomes reported following the Latarjet coracoid process transfer procedure in the adolescent population. Pediatric and adolescent patients with hyperlaxity, and those participating in swimming or gymnastics are more likely to have multidirectional instability (MDI). Non-surgical management with physical therapy is the mainstay of treatment for MDI with positive outcomes reported overall. In young patients with MDI who continue to have symptoms of instability and pain that effects daily activities or sports despite an adequate and appropriate course of rehabilitation, surgical management with capsulorrhaphy may be considered, with promising outcomes reported for both open and arthroscopic techniques. Attentive selection of timing and surgical procedure for pediatric and adolescent patients with anterior shoulder instability may help to prevent recurrent instability following shoulder stabilization. Although most pediatric and adolescent patients with MDI do well following non-surgical management alone, those that fail conservative management have good outcomes following arthroscopic or open capsulorrhaphy.

回顾目的:外伤性和非外伤性肩关节不稳定在儿童和青少年患者中很常见。年轻的肩关节前脱位患者复发性不稳定的风险很高。本综述评估了目前有关小儿和青少年前路不稳定和MDI治疗的文献。最新发现:目前的研究表明,患有肩关节不稳定的儿童和青少年患者在关节镜下Bankart修复后预后良好;然而,术前有一次以上脱位发作的患者(Hill-Sachs病变患者和16岁以下患者)复发性不稳定需要翻修手术治疗的比例较高。在关节镜下Bankart修复术中加入再灌注手术可能有助于预防大Hill-Sachs病变患者复发性不稳定。开放的骨盂增大手术可能适用于严重盂骨丢失的患者,或者那些初次手术治疗失败的患者,Latarjet喙突转移手术在青少年人群中有很好的结果。儿童和青少年高血压患者,以及参加游泳或体操的患者更容易发生多向不稳定(MDI)。非手术治疗和物理治疗是治疗MDI的主要方法,总体上有积极的结果报道。对于年轻的MDI患者,尽管进行了充分和适当的康复治疗,但仍有不稳定和疼痛的症状,影响日常活动或运动,可以考虑采用手术治疗,开放和关节镜技术均有良好的结果。对于患有前路肩关节不稳的儿童和青少年患者,仔细选择时机和手术方法可能有助于防止肩关节稳定后复发性不稳。虽然大多数儿童和青少年MDI患者在单独的非手术治疗后表现良好,但那些保守治疗失败的患者在关节镜下或开放式包膜缝合后预后良好。
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Current Reviews in Musculoskeletal Medicine
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