Flury Matthias P, Goldhahn Joerg, Holzmann Patrick, Simmen Beat R
Schulthess Klinik, Department of Orthopedics, Upper Extremity Unit, Lengghalde, Switzerland.
J Shoulder Elbow Surg. 2007 Nov-Dec;16(6):735-41. doi: 10.1016/j.jse.2007.02.130. Epub 2007 Oct 29.
Weber's internal rotation osteotomy of the humeral head is recommended for the treatment of anteroinferior shoulder instability with a large Hill-Sachs defect. The observation of severe joint degeneration in the course of long-term follow-up provided the motivation for this study. An osteotomy was performed in 42 patients from 1984 to 1990. Thirty-four patients were available for clinical and radiological follow-up after 14.5 years. Our own CT-based classification was applied to categorize the degree of osteoarthritis. A shoulder prosthesis was implanted in 9 patients (26%). Only 3 patients (9%) did not show any signs of degeneration. A statistically significant relationship was found between increased internal rotation of the humeral head and disease severity (P = .03). A lower incidence of joint degeneration (P = .02) was found for patients with generalized ligamentous laxity. We therefore recommend this osteotomy only as a salvage procedure whereby the internal rotation of the humeral head should not exceed 20 degrees .
对于伴有巨大希尔-萨克斯缺损的肩前下不稳定，推荐采用韦伯肱骨头内旋截骨术进行治疗。长期随访过程中观察到的严重关节退变促使开展了本研究。1984年至1990年期间，对42例患者实施了截骨术。14.5年后，34例患者接受了临床和影像学随访。应用我们自己基于CT的分类方法对骨关节炎程度进行分类。9例患者（26%）植入了肩关节假体。仅3例患者（9%）未表现出任何退变迹象。发现肱骨头内旋增加与疾病严重程度之间存在统计学显著相关性（P = 0.03）。发现全身韧带松弛的患者关节退变发生率较低（P = 0.02）。因此，我们仅推荐将此截骨术作为一种挽救手术，其中肱骨头内旋不应超过20度。
