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中华肩肘外科电子杂志 ›› 2025, Vol. 13 ›› Issue (03) : 129 -134. doi: 10.3877/cma.j.issn.2095-5790.2025.03.001

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初次肩关节前脱位治疗策略:从保守到手术的循证决策
邓晓强1, 魏宝刚2,(), 付庆鹏1,()   
  1. 1137400 乌兰浩特,兴安盟人民医院骨关节与运动医学科
    2010017 呼和浩特,内蒙古自治区人民医院骨关节科
  • 收稿日期:2025-07-15 出版日期:2025-08-05
  • 通信作者: 魏宝刚, 付庆鹏

Evidence-based decision-making for the treatment of first-time anterior shoulder dislocation: from conservative to surgical approaches

Xiaoqiang Deng, Baogang Wei(), Qingpeng Fu()   

  • Received:2025-07-15 Published:2025-08-05
  • Corresponding author: Baogang Wei, Qingpeng Fu
引用本文:

邓晓强, 魏宝刚, 付庆鹏. 初次肩关节前脱位治疗策略:从保守到手术的循证决策[J/OL]. 中华肩肘外科电子杂志, 2025, 13(03): 129-134.

Xiaoqiang Deng, Baogang Wei, Qingpeng Fu. Evidence-based decision-making for the treatment of first-time anterior shoulder dislocation: from conservative to surgical approaches[J/OL]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2025, 13(03): 129-134.

本文旨在探讨初次肩关节前脱位的保守治疗与手术治疗的循证依据及最佳适用场景。通过系统回顾分析初次肩关节前脱位相关的病理改变(如Bankart损伤、Hill-Sachs损伤、肩袖损伤等)、影像学评估的价值(包括X线、CT、MRI),以及影响治疗选择的关键因素(如年龄、活动水平和合并损伤),对比了保守治疗与手术治疗在疗效、复发率、并发症及长期预后方面的相关研究证据。结果显示,对于年轻、活跃(尤其是运动员)且存在显著Bankart损伤、关节盂骨缺损(宽度>13.5%或表面积>20%)或较大Hill-Sachs损伤等高危因素的患者,早期关节镜手术能够显著降低复发风险(手术组复发率为6.3%~13.7%,而非手术组为44%~87%),并可能改善远期功能,减少继发损伤。相对而言,对于老年、活动需求低且无显著骨性或软组织损伤的患者,保守治疗是合理的选择,但需警惕肩袖损伤的漏诊。因此,初次肩关节前脱位的治疗应个体化,治疗决策需综合考虑解剖损伤、功能需求、年龄及患者意愿。对于具有明确高危因素的患者,建议选择早期手术治疗(优先考虑关节镜),而低危患者可尝试保守治疗,但需进行密切随访;老年患者则需重点排除肩袖损伤。

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