Iannotti Joseph P, Antoniou John, Williams Gerald R, Ramsey Matthew L
Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA.
J Shoulder Elbow Surg. 2002 Nov-Dec;11(6):618-23. doi: 10.1067/mse.2002.126763.
The surgical management of patients with recurrent anterior instability after failed surgery can be complicated by the loss of capsular tissue and, in some cases, irreparable tears of the subscapularis tendon. We describe a new surgical technique for reconstruction of the capsular ligaments using the iliotibial band (ITB) to reconstruct deficient capsular tissues, and we report the results of 7 patients. All patients had prior surgery, with a mean of 2.2 procedures, and recurrent instability as the primary indication for their index and revision surgeries. After ITB reconstruction, the patients demonstrated significant improvement in their American Shoulder and Elbow Surgeons (ASES) score (P =.0004), and no patient had any persistent symptoms of instability. Physiologic range of motion and function were maintained. We would recommend our method of ITB reconstruction for patients with instability and capsular deficiency after failed surgery and believe that this procedure has advantages over those previously described. Capsular deficiency and persistent instability after prior surgery can occur after prior open or arthroscopic surgery. Capsular deficiency has been described after thermal capsulorrhaphy and is thought to represent excessive thermal injury and tissue necrosis. After open capsulorrhaphy, capsular deficiency can be associated with subscapularis tendon deficiency.(4,6-8,12,13) Capsular deficiency occurring after either open or arthroscopic surgery presents a difficult surgical challenge. The purpose of this case series is to evaluate our experience in the surgical management of recurrent glenohumeral instability after surgery initially performed for treatment of glenohumeral instability that failed and is associated with irreparable tears of the subscapularis and capsular deficiency. The primary objectives of this study are to describe the surgical technique for capsular reconstruction with ITB and to report the clinical results in 7 patients.
手术失败后复发性前向不稳患者的手术治疗可能因关节囊组织缺失而变得复杂，在某些情况下，还会出现肩胛下肌腱无法修复的撕裂。我们描述了一种使用髂胫束（ITB）重建关节囊韧带以修复缺损关节囊组织的新手术技术，并报告了7例患者的结果。所有患者均曾接受过手术，平均手术次数为2.2次，复发性不稳是其初次手术和翻修手术的主要指征。ITB重建术后，患者的美国肩肘外科医师（ASES）评分有显著改善（P = 0.0004），且无一例患者有任何持续性不稳症状。生理活动范围和功能得以维持。对于手术失败后出现不稳和关节囊缺损的患者，我们推荐采用ITB重建方法，并且认为该手术方法比先前描述的方法具有优势。先前的开放手术或关节镜手术后可能会出现先前手术后继发的关节囊缺损和持续性不稳。热关节囊紧缩术后曾有过关节囊缺损的描述，被认为是过度热损伤和组织坏死所致。开放关节囊紧缩术后，关节囊缺损可能与肩胛下肌腱缺损有关。（4,6 - 8,12,13）开放手术或关节镜手术后出现的关节囊缺损带来了困难的手术挑战。本病例系列的目的是评估我们对初次手术治疗盂肱关节不稳失败且伴有肩胛下肌不可修复撕裂和关节囊缺损的患者进行复发性盂肱关节不稳手术治疗的经验。本研究的主要目的是描述使用ITB进行关节囊重建的手术技术，并报告7例患者的临床结果。
