Collin P, Rochcongar P, Thomazeau H
Service de Chirurgie Orthopédique et Reconstructrice, CHU, hôpital sud 16 boulevard de Bulgarie, 35000 Rennes.
Rev Chir Orthop Reparatrice Appar Mot. 2007 Apr;93(2):126-32. doi: 10.1016/s0035-1040(07)90215-9.
Results of the Latarjet procedure for chronic anterior shoulder instability using a coracoid block are known in terms of recurrence, but not in terms of apprehension. We studied a prospective consecutive series of shoulders treated with the Latarjet method in order to determine whether patients forget their shoulder or whether they are still bothered, particularly during sports activities.
The series included 74 patients with chronic anterior shoulder instability treated with a coracoid block according to the Latarjet procedure. Sixty-nine were available for review and 66 had complete radiographic explorations (93.2%). The Duplay score was used to classify sports activities. Mean age was 26.5 years; 90% of the patients practiced sports. The surgical procedure was performed by the same operator for 78% of patients. The Duplay score and the Constant score were determined and standard x-rays (four views) were obtained. Statistical analysis was performed with the chi-square test. Multivariate analysis was then applied to the subpopulation presenting persistent apprehension.
Follow-up was at least 24 months, average follow-up 50 months. Four patients presented secondary dislocation and two subluxation; 85% of patients were satisfied, 6% were hesitant and 9% were dissatisfied. The Duplay score was: excellent (18.8%), good (49.9%), fair (20.2%) and poor (10.1%). External elbow rotation (RE1) was limited by 17.69 degrees compared with the other side. Eighty-seven percent of patients resumed their sports activity five months postoperatively on average; 34% presented persistent apprehension. This subpopulation was examined separately. Multivariate analysis demonstrated two significantly independent factors of persistent apprehension: recovery of RE1 at 30 days postop, and total recovery of R1 at last follow-up. The radiographies demonstrated degenerative lesions in 10.6% of patients.
The satisfaction rate of 85% and the 9% failure rate are similar to earlier reports. Our series was however exceptional in terms of an unusually high rate of persistent apprehension. Statistical analysis did not demonstrate a significant link between the presence of hyperlaxity and persistent apprehension. Nevertheless, in patients with hyperlaxity associated with chronic anterior shoulder instability, we associate Latarjet coracoid block with Neer capsuloplasty.
使用喙突阻滞的Latarjet手术治疗慢性肩关节前向不稳的复发情况已有报道，但恐惧情况未知。我们对一系列采用Latarjet方法治疗的肩关节进行前瞻性连续研究，以确定患者是否不再担心肩部问题，或者他们是否仍然受到困扰，特别是在体育活动期间。
该系列包括74例采用喙突阻滞并根据Latarjet手术治疗的慢性肩关节前向不稳患者。69例可供复查，66例进行了完整的影像学检查（93.2%）。使用Duplay评分对体育活动进行分类。平均年龄为26.5岁；90%的患者进行体育活动。78%的患者由同一名手术医生进行手术。测定Duplay评分和Constant评分，并获取标准的X线片（四张视图）。采用卡方检验进行统计分析。然后对存在持续恐惧的亚组进行多变量分析。
随访至少24个月，平均随访50个月。4例出现继发性脱位，2例半脱位；85%的患者满意，6%犹豫不决，9%不满意。Duplay评分情况为：优秀（18.8%）、良好（49.9%）、中等（20.2%）和差（10.1%）。患侧肘外旋（RE1）较对侧受限17.69度。87%的患者术后平均5个月恢复体育活动；34%存在持续恐惧。对该亚组进行单独检查。多变量分析显示持续恐惧的两个显著独立因素：术后30天RE1的恢复情况，以及最后随访时R1的完全恢复情况。影像学检查显示10.6%的患者有退行性病变。
85%的满意率和9%的失败率与早期报告相似。然而，我们的系列研究中持续恐惧的发生率异常高。统计分析未显示关节过度松弛与持续恐惧之间存在显著关联。尽管如此，对于伴有慢性肩关节前向不稳且关节过度松弛的患者，我们将Latarjet喙突阻滞与Neer关节囊成形术联合应用。
