唑来膦酸与阿仑膦酸钠预防PKP术后再骨折的效果分析

目的比较分析静脉滴注唑来膦酸与口服阿仑膦酸钠预防经皮椎体后凸成形(PKP)术后预防骨质疏松性再骨折的效果。方法纳入2014-01—2017-12行PKP手术并获得完整随访的92例骨质疏松性胸腰椎压缩骨折,术后进行规范抗骨质疏松治疗,46例在口服碳酸钙D3片、骨化三醇胶丸基础上口服阿仑膦酸钠治疗(阿仑膦酸钠组),46例在基础治疗后静脉滴注唑来膦酸治疗(唑来膦酸组)。结果 92例均获得随访,随访时间平均16(12～24)个月。阿仑膦酸钠组与唑来膦酸组术后3 d疼痛VAS评分、伤椎椎体前缘高度比值、伤椎Cobb角差异无统计学意义(P0.05)。唑来膦酸组再次骨折发生率低于阿仑膦酸钠组,末次随访时骨密度高于阿仑膦酸钠组,差异有统计学意义(P 0.05)。结论 PKP术后出现骨质疏松性再骨折的主要原因是骨质疏松症控制不佳,对于此类患者术后应重视规范抗骨质疏松治疗,而唑来膦酸预防骨质疏松性再骨折的效果明显优于口服阿仑膦酸钠。     

唑来膦酸、伊班膦酸钠及阿伦膦酸钠防治绝经后骨质疏松症的疗效对比研究

目的对比研究唑来膦酸、伊班膦酸钠及阿伦膦酸钠对绝经后骨质疏松症的疗效。方法 180名绝经后妇女随机分为唑来膦酸治疗组(ZOL组)、伊班膦酸钠治疗组(IBA组)和阿伦膦酸钠治疗组(ALN组);ZOL组给予唑来膦酸治疗,IBA组给予伊班膦酸钠治疗,ALN组予以阿伦膦酸钠治疗。治疗前后分别检测3组受试者腰椎及髋部骨密度、血清骨代谢指标、视觉模拟评分(visual analogue scale,VAS)改变及研究期间药物不良反应和骨折发生率。结果药物治疗12个月后3组腰椎(L1~4)及左侧股骨颈骨密度明显增加,显著高于治疗前(P0.05),而3组间比较差异无统计学意义(P0.05),3组治疗有效率比较差异无统计学意义(P0.05)。药物治疗12个月后3组患者的VAS评分均显著降低,显著低于治疗前(P0.05),而3组间比较差异无统计学意义(P0.05)。干预12个月后两组血清I型胶原交联羧基末端肽和抗酒石酸酸性磷酸酶-5b水平均显著降低,显著低于治疗前(P0.05),而3组间比较差异无统计学意义(P0.05)。3组间药物不良反应发生率比较差异无统计学意义(P0.05)。结论唑来膦酸、伊班膦酸钠及阿伦膦酸钠对绝经后骨质疏松症的治疗安全有效,可以显著改善骨密度及骨代谢异常。     

密固达在老年骨质疏松治疗中的安全观察

目的本研究通过与口服阿仑膦酸钠(alendronate sodium)的对比,旨在评价老年人使用唑来膦酸注射液(zoledronic acid)的疗效、应用、安全性、依从性。方法回顾性分析2012年8月至2013年9月,重庆医科大学附属第一医院的116例原发性骨质疏松患者的医疗记录。两组药物组各包含58例,选取绝经后妇女、60岁以上原发性骨质疏松患者且首次使用阿仑膦酸钠/唑来膦酸注射液患者入组。通过对比两组用药前后腰椎和(或)髋部骨密度改变、依从性、不良反应和新发骨折率,比较两种药物的疗效。结果两组入组患者性别、年龄、骨密度相似。唑来膦酸注射液组的骨密度增加量比阿仑膦酸钠组有显著差异,其中腰椎骨密度(P=0.007)、髋部骨密度(P=0.006)。唑来膦酸注射液组有更多的不良反应(n=50);新发骨折数较阿仑膦酸钠组少(n=12)。两组患者中,疼痛为主的主观症状以视觉模拟标度尺(visual analogue scale,VAS)表示,唑来膦酸注射液组中疼痛症状明显缓解(P0.01)。两组中治疗前后血钙(blood calcium,BC)和碱性磷酸酶(alkaline phosphatase,AP)均无明显差异。结论唑来膦酸注射液治疗老年性骨质疏松更优于阿仑膦酸钠。在提高腰椎及髋部骨密度方面疗效相似。虽然在治疗前3天有更多的不良反应,但减少了新发骨折率,缓解症状更显著。两组药物对血生化的影响均无明显差异。     

唑来膦酸联合瑞舒伐他汀辅助治疗老年骨质疏松性椎体压缩性骨折临床观察

目的探讨唑来膦酸联合瑞舒伐他汀辅助治疗老年骨质疏松椎体压缩性骨折的临床观察。方法 108例老年压缩性骨折女性患者随机分为对照组和治疗组。两组患者均进行给予PVP结合抗骨质疏松药物唑来膦酸治疗,治疗组在术后加用瑞舒伐他汀治疗。分别在治疗前后12个月评定两组患者视觉模拟疼痛评分(VAS)及Oswestry功能障碍指数评分(ODI);治疗前后12个月检测患者骨密度及骨特异性碱性磷酸酶(BAP)和I型前胶原肽(CTX);观察两组患者药品不良反应及邻近椎体再骨折发生情况。结果治疗后12个月两组患者VAS与ODI评分均较治疗前有明显改善(P0.05),且治疗组患者评分明显低于对照组(P0.05)。治疗后12个月,治疗组患者骨密度较治疗前显著改善(P0.05),血清BAP和CTX较术前明显下降(P0.05),且均明显优于对照组(P0.05)。两组药品不良反应发生率比较,差异无统计学意义(P0.05);而邻近椎体再骨折发生率治疗组相对对照组明显降低,比较有统计学意义(P0.05)。结论唑来膦酸联合瑞舒伐他汀治疗老年骨质疏松椎体压缩性骨折疗效较好,能增加患者骨密度,降低邻近椎体再骨折发生率,降低骨吸收水平,安全性好。     

唑来膦酸与特立帕肽对骨质疏松患者腰椎椎间融合影响的对比分析

目的：比较唑来膦酸与特立帕肽对骨质疏松患者腰椎间融合的影响。方法：前瞻性纳入2016年3月至2018年10月行后路腰椎间融合术合并骨质疏松患者91例,根据患者自行选择接受的治疗方式分为基础对照组22例、唑来膦酸组39例和特立帕肽组30例,分别采用基础抗骨质疏松治疗、辅助唑来膦酸或者特立帕肽抗骨质疏松治疗促进椎间骨融合。术后1年、2年随访时采用双能X线骨密度仪测量髋部骨密度,采用CT检查评估椎间融合情况,同时记录腰腿痛视觉模拟量表（VAS）评分和下肢Oswestry功能障碍指数（ODI）评分以评估临床效果。结果：最终基础对照组21例、唑来膦酸组37例及特立帕肽组26例完成2年随访。三组患者术前一般临床资料差异无统计学意义（P>0.05）,具有可比性。术后1年,特立帕肽组、唑来膦酸组患者髋部骨密度均较术前提高（P<0.05）;特立帕肽组患者椎间融合率均高于基础对照组及唑来膦酸组患者（P<0.05）。术后2年,特立帕肽组、唑来膦酸组患者髋部骨密度均高于基础对照组患者（P<0.05）,且特立帕肽组患者髋部骨密度高于唑来膦酸组患者（P<0.05）;特立帕肽组、唑来膦...     

唑来膦酸治疗老年女性骨质疏松性椎体压缩性骨折效果观察

目的观察唑来膦酸辅助治疗女性骨质疏松性椎体压缩性骨折效果。方法 126例老年压缩性骨折女性患者随机分为对照组和治疗组。两组患者均进行给予PVP治疗,治疗组给予唑来膦酸5 mg治疗。治疗前及治疗12个月后使用视觉模拟疼痛评分(VAS)及Oswestry功能障碍指数评分(ODI)评价患者疼痛改善情况;治疗前及治疗12个月检测患者骨密度改变情况和骨代谢指标:骨钙素(BGP)和I型前胶原肽(CTX)水平的变化。结果治疗后12个月,两组患者VAS与ODI评分较治疗前均有显著改善(P0.05),且治疗组患者上述评分改善情况较对照组更为明显(P0.05)。治疗后12个月,治疗组骨密度较治疗前明显升高(P0.05),血清CTX较治疗前明显降低(P0.05),和对照组比较差异有统计学意义(P0.05);而治疗前后BGP无明显改变(P0.05),对照组上诉指标治疗前后比较,差异无统计学意义(P0.05)。结论唑来膦酸有助于改善老年骨质疏松椎体压缩性骨折术后骨密度和骨代谢,降低VAS与ODI评分,值得临床推广。     

阿仑膦酸钠预防骨质疏松性脊柱骨折患者再次骨折的临床研究

目的观察阿仑膦酸钠预防骨质疏松性脊柱骨折患者再次骨折的作用。方法将80例骨质疏松性脊柱骨折患者随机分为治疗组及对照组,每组40例。2组均应用碳酸钙D3片及阿法骨化醇软胶囊做为基础用药,治疗组加用阿仑膦酸钠。分别于治疗开始前及治疗2年后．检测2组患者腰椎及左侧髋部双能X线骨密度（BMD）,并测定血清I型胶原氨基末端肽（NTX）和骨钙素（OC）浓度,随访再次骨折的发生率。结果阿仑膦酸钠治疗组治疗2年,腰椎及左侧髋部BMD均不同程度提高,血清NTX及OC则不同程度降低,与治疗前相比差异有统计学意义（P〈0．05）。对照组BMD均不同程度下降,血清NTX及OC则不同程度升高,但无统计学意义（P〉0．05）。两组相比差异有统计学意义（P〈0．05）。2年治疗中,治疗组发生2例再次骨折事件,对照组发生8例再次骨折事件,两组相比差异有统计学意义（P〈0．05）。结论阿仑膦酸钠能够有效降低骨转换率、增加BMD,预防骨质疏松性脊柱骨折患者再次骨折的发生。     

唑来膦酸治疗老年患者高转换型骨质疏松症的临床效果及其对骨代谢标志物的影响

目的分析唑来膦酸治疗老年患者高转换型骨质疏松症的临床效果及其对骨代谢标志物的影响。方法回顾性分析2013年1月至2018年1月辽宁省金秋医院收治的老年骨质疏松患者66例,其中女性60人,男性6人,年龄65～88岁,平均年龄(69.5±9.8)岁。所有纳入老年患者均为高转换型骨质疏松,分为治疗组和对照组。治疗组32例给予静脉应用唑来膦酸5mg,同时口服骨化三醇及钙剂治疗;对照组34例,仅口服骨化三醇及钙剂治疗;在治疗组中,比较治疗前后骨密度、VAS疼痛评分、骨代谢标志物PINP和β-CTX的变化。两组间比较,治疗后骨密度升高值、VAS疼痛评分下降值、骨代谢标志物PINP和β-CTX下降值的变化。观察治疗后的药物不良反应情况。结果治疗前两组患者在年龄、性别构成、骨密度值和VAS评分方面差异均无统计学意义(P0.05)。治疗组中,与治疗前相比,治疗后骨密度值明显增加(P0.05),VAS评分明显降低(P0.05),PINP和β-CTX水平均明显降低(P0.05)。与对照组比较,治疗后各时间点,治疗组骨密度值均明显增加(P0.05),VAS疼痛评分均明显降低(P0.05),PINP和β-CTX水平均明显下降(P0.05)。治疗组用药后出现5例发热,2例流感样症状,均在2～3 d内消失。结论唑来膦酸可以用于治疗老年骨质疏松,能够显著改善腰椎及髋部骨密度,有效缓解疼痛症状,改善骨代谢标志物水平,药物不良反应少。     

阿仑膦酸钠治疗骨折后骨质疏松临床观察

目的观察阿仑膦酸钠治疗重症骨折继发骨质疏松的临床疗效。方法选取2017年8月至2018年11月空军特色医学中心收治的60例重症骨折继发骨质疏松患者作为研究对象,根据入院的基偶顺序分别设为对照组和治疗组,各30例。对照组在骨折三个月后给予常规治疗,治疗组则在骨折三个月后在对照组的治疗基础上给予口服阿仑膦酸钠治疗,两组均治疗三个月,观察比较两组患者临床疗效,检测治疗前后两组患者骨代谢标志物I型胶原交联氨基端肽(NTXI)、I型胶原交联羧基端肽(CTXI)、抗酒石酸酸性磷酸酶5b(TRACP5b)和血骨钙素(BGP)、骨密度(bone mineral density,BMD)、骨碱性磷酸酶(BALP)。结果治疗前两组患者的NTXI、CTXI、TRACP5b、BGP、BMD和BALP等均无显著性差异(P0. 05)。治疗后,治疗组的总有效率为93. 3%明显高于对照组的70. 0%(P0. 05);治疗组的NTXI、CTXI、TRACP5b、BGP、BMD和BALP较对照组均明显改善,差异具有统计学意义(P0. 05)。结论阿仑膦酸钠治疗重症骨折继发骨质疏松的临床疗效显著,值得临床推广。     

唑来膦酸和特立帕肽对预防椎体成形术后再发骨折的疗效比较

目的比较唑来膦酸和特立帕肽对椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)术后再发骨折的影响。方法收集2016年6月到2017年6月在我院骨科接受PVP治疗且符合条件的女性患者共60例,其中40人在术后接受了唑来膦酸治疗(A组),20人在术后接受了特立帕肽治疗(B组),两组患者均给予维生素D和钙剂基础治疗。术前、术后6月、末次随访行骨代谢指标血清I型前胶原N末端前肽(PINP)和Ⅰ型胶原羧基端β降解产物(β-CTX)检测及骨密度检测,同时记录随访期间再发骨折不良事件。结果 A组患者术后6个月PINP和β-CTX值较术前显著下降(P0. 05),而末次随访时PINP较术后6月未见明显改变,β-CTX则进一步降低,差异具有统计学意义(P0. 05); A组患者术后6月和末次随访骨密度检测与术前相比虽有增长,但差异未见统计学意义(P0. 05)。B组患者术后6个月PINP和β-CTX值较术前显著上升,且其上升趋势可以维持到末次随访,与术前比较差异具有统计学意义(P0. 05); B组患者术后6个月骨密度较术前明显提高(P0. 05),尽管在末次随访时骨密度略有降低,但仍较术前明显升高(P0. 05)。A组再发骨折率(10/40,25%)明显高于B组(1/20,5%),相关性分析显示再发骨折与骨密度(r=0. 028,P0. 05)和PINP检测值(r=-0. 013,P0. 05)密切相关。结论特立帕肽较唑来膦酸能更好预防椎体成形术后再发骨折,其潜在机制与更有效改善骨代谢,提高骨密度有关。     

Bone cement with reduced proportion of monomer in total hip arthroplasty: Preclinical evaluation and randomized study of 47 cases with 5 years' follow-up

Bone cement with reduced amount of monomer and low curing temperature may improve implant fixation due to reduced toxicity. We analyzed the mechanical, chemical and thermal properties of such a cement (Cemex Rx) using Palacos R as control. The in vivo performance of the 2 cements was also evaluated in a prospective randomized study of 47 hips, where either of the cement types was used to fixate Lubinus SP2 prostheses with the stem made of titanium alloy. Cemex Rx had a reduced tensile strength, probably because this cement was manually mixed, as recommended by the manufacturer. A standardized laboratory test showed lower curing temperature for Cemex, but measurements at 37° and with prechilled Palacos R and Cemex Rx, as in clinical work, showed no difference. In the clinical study radiostereometric measurements of cup and stem migration showed similar values in the 2 groups up to 5 years after the operation. The cement mantle was stable in both groups, but the stems migrated similarly inside the cement mantle regardless of the type of cement used. Proximal wear was low (0.04-0.05 mm/year) and tended to be lower in the Cemex group (p = 0.02). Aluminum and vanadium levels in serum increased 5 years after the operation, but no difference was noted between the 2 groups. Collagen markers (PICP, ICTP) showed similar increases in bone turnover 6 weeks and 6 months after operation in both groups.     

Osteogenesis after Bone and Bone Marrow Transplantation: II. The Initial Cellular Events Following Transplantation of Decalcified Allografis of Cancellous Bone

An experimental study was done in rabbits to investigate the fate of allogeneic iliac cancellous bone, both non-decalcified and decalcified with hydrochloric acid, transplanted to a muscular site for up to 14 days. Some of the treated allografts were impregnated with autologous bone marrow cells, obtained from the femoral medulla by aspiration, and each was compared with allografts alone. Combined myelo-osseous grafts produced bone after 7 to 8 days implantation, as did marrow autografts alone. In addition non-decalcified implants stimulated the production of multinucleated giant cells. Three different types of wash solution were used but these did not influence the cell population seen, nor the new bone formation. It is concluded that the critical events in bone formation after transplantation occur less than 8 days after the transplantation and that marrow cells have osteogenic capacity. This has relevance to the clinical aspects of bone grafting.     

Bone microstructure at the distal tibia provides a strength advantage to males in late puberty: An HR‐pQCT study

Bone is a complex structure with many levels of organization. Advanced imaging tools such as high‐resolution (HR) peripheral quantitative computed tomography (pQCT) provide the opportunity to investigate how components of bone microstructure differ between the sexes and across developmental periods. The aim of this study was to quantify the age‐ and sex‐related differences in bone microstructure and bone strength in adolescent males and females. We used HR‐pQCT (XtremeCT, Scanco Medical, Geneva, Switzerland) to assess total bone area (ToA), total bone density (ToD), trabecular bone density (TrD), cortical bone density (CoD), cortical thickness (Cort.Th), trabecular bone volume (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular spacing standard deviation (Tb.Sp SD), and bone strength index (BSI, mg²/mm⁴) at the distal tibia in 133 females and 146 males (15 to 20 years of age). We used a general linear model to determine differences by age‐ and sex‐group and age × sex interactions (p < 0.05). Across age categories, ToD, CoD, Cort.Th, and BSI were significantly lower at 15 and 16 years compared with 17 to 18 and 19 to 20 years in males and females. There were no differences in ToA, TrD, and BV/TV across age for either sex. Between sexes, males had significantly greater ToA, TrD, Cort.Th, BV/TV, Tb.N, and BSI compared with females; CoD and Tb.Sp SD were significantly greater for females in every age category. Males' larger and denser bones confer a bone‐strength advantage from a young age compared with females. These structural differences could represent bones that are less able to withstand loads in compression in females. © 2010 American Society for Bone and Mineral Research     

Building better bone: The weaving of biologic and engineering strategies for managing bone loss

Segmental bone loss remains a challenging clinical problem for orthopaedic trauma surgeons. In addition to the missing bone itself, the local tissues (soft tissue, vascular) are often highly traumatized as well, resulting in a less than ideal environment for bone regeneration. As a result, attempts at limb salvage become a highly expensive endeavor, often requiring multiple operations and necessitating the use of every available strategy (autograft, allograft, bone graft substitution, Masquelet, bone transport, etc.) to achieve bony union. A cost‐sensitive, functionally appropriate, and volumetrically adequate engineered substitute would be practice‐changing for orthopaedic trauma surgeons and these patients with difficult clinical problems. In tissue engineering and bone regeneration fields, numerous research efforts continue to make progress toward new therapeutic interventions for segmental bone loss, including novel biomaterial development as well as cell‐based strategies. Despite an ever‐evolving literature base of these new therapeutic and engineered options, there remains a disconnect with the clinical practice, with very few translating into clinical use. A symposium entitled “Building better bone: The weaving of biologic and engineering strategies for managing bone loss,” was presented at the 2016 Orthopaedic Research Society Conference to further explore this engineering‐clinical disconnect, by surveying basic, translational, and clinical researchers along with orthopaedic surgeons and proposing ideas for pushing the bar forward in the field of segmental bone loss. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1855–1864, 2017.

     

重组合异种骨植骨修复骨囊肿所致骨缺损

2001年10月～2003年9月,笔者共收治28例骨囊肿患者,均采用病灶刮除,瘤腔灭活和重组合异种骨植骨治疗,获得满意疗效,体会如下。     

感染性骨缺损的治疗及研究进展

感染性骨缺损由于存在感染及骨缺损双重病变,治疗棘手,疗程长,且易出现肌肉萎缩、局部瘢痕而致肢体功能受到严重影响.近年来随着外固定技术、显微外科技术、生物材料技术及骨组织工程技术等的发展,感染性骨缺损的治疗取得明显进步,短缩了治疗时间,且效果显著,笔者对其研究进展综述如下.     

The benefit of bone marrow concentrate in addition to a glass‐reinforced hydroxyapatite for bone regeneration: An in vivo ovine study

This study evaluates the ability of a Glass Reinforced Hydroxyapatite Composite (GRHC), in a new microporous pellet formulation with autologous bone marrow concentrate (BMC), to enhance bone regeneration and new bone formation. Ninety non‐critical sized bone defects were created in the femurs of nine Merino breed sheep and randomly left unfilled (group A), filled with GRHC pellets alone (group B) or filled with GRHC pellets combined with BMC (group C). The sheep were sacrificed at 3 weeks (three sheep), 6 weeks (three sheep) and 12 weeks (three sheep) and histological analysis (Light Microscopy‐LM), scanning electron microscopy (SEM) and histomorphometric analysis (HM) were performed. At 3, 6, and 12 weeks, HM revealed an average percentage of new bone of 48, 72, 83%; 25, 73, 80%, and 16, 38, 78% for Groups C, B and A respectively (significantly different only at 3 weeks p < 0.05). LM and SEM evaluation revealed earlier formation of well‐organized mature lamellar bone in Group C. This study demonstrates that the addition of a bone marrow concentrate to a glass reinforced hydroxyapatite composite in a pellet formulation promotes early bone healing. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1176–1182, 2017.

     

Massive bone reconstruction with heat‐treated bone graft loaded autologous bone marrow‐derived stromal cells and β‐tricalcium phosphate composites in canine models

Bone marrow‐derived stromal cells (BMSCs) contain mesenchymal stem cells that are capable of forming various mesenchymal tissues. We hypothesized that BMSCs and β‐tricalcium phosphate (β‐TCP) composites would promote the remodeling of large‐sized autologous devitalized bone grafts; therefore, the aim of this study was to evaluate the effects of the composites on the remodeling of autologous devitalized bone grafts. Autologous BMSCs cultured in culture medium containing dexamethasone (10^?7 M) were loaded into porous β‐TCP granules under low‐pressure. Theses BMSC/TCP composites were put into the bone marrow cavity of autologous heat‐treated bone (femoral diaphysis, 65‐mm long, 100°C, 30 min) and put back to the harvest site. In the contralateral side, β‐TCP without BMSC were used in the same manner as the opposite side as the control. Treatment with the BMSC/TCP composites resulted in a significant increase in thickness, bone mineral density, and matured bone volume of the cortical bone at the center of the graft compared to the control. Histological analysis showed matured regenerated bone in the BMSC loaded group. These results indicate that BMSC/TCP composites facilitated bone regeneration and maturation at the graft site of large‐sized devitalized bone. This method could potentially be applied for clinical use in the reconstruction of large bone defects such as those associated with bone tumors. © 2013 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 31:1308–1316, 2013

     

The Penetration of Lincomycin into Normal Human Bone: Determinations of Penetration into Compact Bone, Spongy Bone and Bone Marrow

The penetration of lincomycin into normal bone was studied in 10 patients with fracture of the neck of the femur, a separate determination being made of the lincomycin concentration in serum, bone marrow, spongy bone and compact bone. The concentration of lincomycin in bone marrow was found to be at the same level as that in the serum. The concentration in spongy bone amounted in most cases to 50 to 75 per cent of the concentration in the serum, whereas the concentration in compact bone varied from 0 to 15 per cent of that in the serum.     

Oxyphenbutazone (Tanderil®) in Surgery for Herniated Discs: A Double Blind Trial

Background and purpose In detection of glenoid labrum pathology, MR arthrography (MRA) has shown sensitivities of 88-100% and specificities of 89-93%. However, our practice suggested that there may be a higher frequency of falsely negative reports. We assessed the accuracy of this costly modality in practice.

Patients and methods We retrospectively reviewed MRA reports of 90 consecutive patients with clinical shoulder instability who had undergone shoulder arthroscopy. All had a history of traumatic anterior shoulder dislocation and had positive anterior apprehension tests. All underwent arthroscopy and stabilization during the same procedure. We compared the findings, using arthroscopic findings as the gold standard in the identification of glenoid labrum pathology.

Results 83 of the 90 patients had glenoid labrum tears at arthroscopy. Only 54 were correctly identified at MRA. All normal glenoid labra were identified at MRA. This gave a sensitivity of 65% and a specificity of 100% in identification of all types of glenoid labrum tear. 74 patients had anterior glenoid labral tears that were detected at an even lower rate of sensitivity (58%).

Interpretation The sensitivity of MRA in this series was substantially lower than previously published, suggesting that MRA may not be as reliable a diagnostic imaging modality in glenohumeral instability as previously thought. Our findings highlight the importance of an accurate history and clinical examination in the management of glenohumeral instability. The need for MRA may not be as high as is currently believed.