双同种异体肩关节稳定治疗多向不稳定性可改善2年后的功能和生存能力

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-06-01 DOI:10.1016/j.asmr.2025.101120

Felix H. Savoie III M.D. , Matthew W. Cole M.D. , Lacee K. Collins B.S. , J. Heath Wilder M.D. , Bailey J. Ross M.D. , Michael J. O’Brien M.D. , William F. Sherman M.D., M.B.A.

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引用次数: 0

摘要

目的描述双同种异体移植技术用于严重症状性多向不稳定和肩关节过度松弛的患者，并介绍Beighton评分的修改，以帮助确定何时应使用该手术，并报告该手术在治疗这些患者中的长期结果。方法回顾性分析广泛物理治疗失败后采用双异体移植技术治疗的多向骨不稳患者。最终分析包括43例患者（46肩）。纳入的患者至少有2年的办公室随访，Tulane修改的Beighton评分为11或更高，严重的多向不稳定/肩部过度松弛。术前和术后患者报告的预后（PRO）指标采用双尾配对t检验进行比较。采用双尾独立t检验进行亚组分析。结果：术后6个月随访时，所有PRO指标的平均术后结局评分与术前评分相比均有显著提高。措施)。性别、年龄和有无遗传证实的埃勒-丹洛斯综合征患者的亚组分析在PRO评分的术后改善方面是相同的。杜兰大学的平均分是14分，范围在11到15分之间。在46例手术病例中，共有7例（15.2%）出现并发症，5例复发需要再次手术。5例（10.9%）患者接受后续翻修手术，平均时间为5.36±2.64年。结论双异体移植重建技术是恢复严重韧带松弛患者肩关节稳定性的一种安全有效的方法。证据水平：IV级，治疗性病例系列。

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Double-Allograft Shoulder Stabilization for Multidirectional Instability Is Associated With Improved Function and Survivability After 2 Years

Purpose

To describe a double-allograft technique used for patients with severe, symptomatic multidirectional instability and hyperlaxity of the shoulder as well as to introduce a modification of the Beighton score that helps determine when this procedure should be utilized and report long-term outcomes of this procedure in the management of these patients.

Methods

A retrospective review of patients with multidirectional instability who were managed with the double-allograft technique after failure of extensive physical therapy was conducted. The final analysis included 43 patients (46 shoulders). Included patients had minimum 2 years of in-office follow-up with a Tulane modified Beighton score of 11 or greater and severe multidirectional instability/hyperlaxity of the shoulder. Preoperative and postoperative patient-reported outcome (PRO) measures were compared using 2-tailed paired t -tests. Subgroup analyses were performed using 2-tailed, independent t-tests.

Results

Mean postoperative outcome scores were significantly improved compared with preoperative scores for all PRO measures evaluated from the 6-month postoperative visit on (all P < .001). Subgroup analyses of gender, age, and patients with versus without genetically confirmed Ehlers-Danlos syndrome were equivalent with respect to postoperative improvements in PRO scores. The average Tulane modified Beighton score was 14, range 11 to 15. Among the 46 operative cases, there were a total of 7 (15.2%) complications and 5 recurrences requiring additional surgery. The 5 (10.9%) patients who underwent a subsequent revision procedure did so at a mean time of 5.36 ± 2.64 years.

Conclusions

The double allograft reconstruction technique appears to be a safe and effective method to restore shoulder stability in patients with severe ligamentous laxity.