Clinical Features of the Different Types of SLAP Lesions: An Analysis of One Hundred and Thirty-nine Cases

Tae Kyun Kim, W. S. Queale, A. Cosgarea, E. McFarland
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引用次数: 268

Abstract

Background: Previous studies have suggested that SLAP (superior labrum anterior posterior) lesions are a distinct clinical entity. The goals of this study were to define the prevalence, associated pathological findings, and clinical features of the different types of SLAP lesions with use of a common classification system.Methods: Five hundred and forty-four patients undergoing shoulder arthroscopy for a variety of diagnoses were prospectively included in this consecutive case series. SLAP lesions were grouped with use of the Snyder classification. Demographic data, clinical data, and arthroscopic findings in the groups with SLAP lesions were compared with those in a control group with no SLAP lesion.Results: Of 544 shoulder arthroscopy procedures, 139 (26%) demonstrated a SLAP lesion. One hundred and three (74%) of the SLAP lesions were Type I, twenty-nine (21%) were Type II, one (0.7%) was Type III, and six (4%) were Type IV. Most (123) of the SLAP lesions were found to be associated with other intra-articular lesions. Multivariate analysis revealed that a positive Speed test and a supraspinatus tear were significantly associated with Type-I lesions (p = 0.012 and p = 0.001, respectively). The findings associated with Type-II lesions differed according to the patient's age: Type-II lesions in patients who were forty years of age or younger were associated only with a Bankart lesion, whereas those in patients older than forty years of age were associated with a supraspinatus tear and osteoarthritis of the humeral head. Type-III and Type-IV lesions were associated with a high-demand occupation and a Bankart lesion.Conclusions: This study demonstrated that the prevalence, associated pathological findings, and clinical features of the different types of SLAP lesions vary with the patient population that is studied. Also, the clinical features and pathological findings associated with the different types of SLAP lesions often overlap. Isolated SLAP lesions with no associated pathological findings are uncommon, and care must be taken when ascribing symptoms to a SLAP lesion when other lesions are present.Level of Evidence: Diagnostic study, Level IV-1 (case-control study). See p. 2 for complete description of levels of evidence.
139例不同类型SLAP病变的临床特征分析
背景:以前的研究表明,SLAP(上唇前后)病变是一个独特的临床实体。本研究的目的是使用一个通用的分类系统来定义不同类型的SLAP病变的患病率、相关病理表现和临床特征。方法:544例因各种诊断而接受肩关节镜检查的患者前瞻性地纳入了这个连续的病例系列。使用Snyder分类对SLAP病变进行分组。将有SLAP病变组的人口统计学资料、临床资料和关节镜检查结果与无SLAP病变的对照组进行比较。结果:在544例肩关节镜手术中,139例(26%)显示SLAP病变。1型病变103例(74%),2型病变29例(21%),3型病变1例(0.7%),4型病变6例(4%)。绝大多数(123例)SLAP病变合并其他关节内病变。多变量分析显示,Speed试验阳性和冈上肌撕裂与i型病变显著相关(p = 0.012和p = 0.001)。ii型病变的相关结果因患者的年龄而异:40岁或以下患者的ii型病变仅与Bankart病变相关,而40岁以上患者的ii型病变与冈上肌撕裂和肱骨头骨关节炎相关。iii型和iv型病变与高需求职业和Bankart病变相关。结论:本研究表明,不同类型的SLAP病变的患病率、相关病理表现和临床特征随所研究的患者人群而异。此外,与不同类型的SLAP病变相关的临床特征和病理表现经常重叠。没有相关病理发现的孤立性SLAP病变并不常见,当存在其他病变时,将症状归因于SLAP病变时必须小心。证据等级:诊断性研究,IV-1级(病例对照研究)。关于证据等级的完整描述见第2页。
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