Chuang Tai-Yuan, Adams Christopher R, Burkhart Stephen S
The San Antonio Orthopaedic Group, San Antonio, Texas, USA.
Arthroscopy. 2008 Apr;24(4):376-82. doi: 10.1016/j.arthro.2007.10.008. Epub 2007 Dec 31.
The purpose of this study was to determine if three-dimensional computed tomography (3-D CT) scans of the glenoid can be used to accurately quantify, by means of a glenoid index, bone loss in patients with anterior glenohumeral instability, and to compare the results with arthroscopic measurements to determine if the 3-D CT scan can preoperatively predict which patients with anterior glenohumeral instability will benefit from a bone grafting procedure.
From 2003 to 2006, 188 patients with anterior glenohumeral instability underwent arthroscopic evaluation and treatment by the senior author (S.S.B.). Of 188 total patients, there were 25 patients ranging in age from 15 to 43 years (median, 19 years) who underwent 3-D CT evaluations of both shoulders followed by arthroscopy of the unstable shoulder. For an arthroscopically measured bone loss of less than 25% of the inferior glenoid diameter, an arthroscopic Bankart repair was performed; for a glenoid bone loss of greater than or equal to 25%, an open Latarjet reconstruction was performed. We defined the glenoid index as the ratio of the maximum inferior diameter of the injured glenoid compared to the maximum inferior diameter of the uninjured contralateral glenoid as calculated from the 3-D CT scans. If the glenoid index was greater than 0.75, the patient was predicted to benefit from an arthroscopic Bankart repair (the need for surgery and the type of surgery having been determined on the basis of arthroscopic measurements). However, if the glenoid index was less than or equal to 0.75, the patient was predicted to benefit from an open Latarjet procedure. The results of each patient's glenoid index were compared with the arthroscopic decision to perform either an arthroscopic Bankart repair or an open Latarjet procedure.
Of the 25 patients included in this study, 13 patients underwent an open Latarjet procedure and 12 patients underwent an arthroscopic Bankart repair. The 3-D CT scans accurately predicted the arthroscopic decisions to perform an arthroscopic Bankart repair or open Latarjet in 24 (96%) of 25 cases (Fisher exact test; P < .001).
The glenoid index as calculated from the 3-D CT scan accurately predicted the requirement of a bone grafting procedure for 24 (96%) of 25 patients when the benchmark value of 0.75 was used. The 3-D CT scan can therefore be used by surgeons as an additional diagnostic tool for preoperative planning and patient counseling.
Level III, development of diagnostic criteria with universally applied reference (nonconsecutive patients).
本研究的目的是确定通过关节盂指数，利用三维计算机断层扫描（3-D CT）对盂肱关节前不稳定患者的骨丢失进行准确量化，并将结果与关节镜测量结果进行比较，以确定3-D CT扫描能否在术前预测哪些盂肱关节前不稳定患者将从骨移植手术中获益。
2003年至2006年，188例盂肱关节前不稳定患者接受了资深作者（S.S.B.）的关节镜评估和治疗。在188例患者中，有25例年龄在15至43岁（中位数19岁），对其双肩进行了3-D CT评估，随后对不稳定的肩部进行了关节镜检查。对于关节镜测量的骨丢失小于关节盂下直径的25%的患者，进行关节镜下Bankart修复；对于关节盂骨丢失大于或等于25%的患者，进行开放Latarjet重建。我们将关节盂指数定义为根据3-D CT扫描计算得出的受伤关节盂最大下直径与未受伤对侧关节盂最大下直径之比。如果关节盂指数大于0.75，则预测该患者将从关节镜下Bankart修复中获益（手术需求和手术类型已根据关节镜测量确定）。然而，如果关节盂指数小于或等于0.75，则预测该患者将从开放Latarjet手术中获益。将每位患者的关节盂指数结果与进行关节镜下Bankart修复或开放Latarjet手术的关节镜决策进行比较。
本研究纳入的25例患者中，13例接受了开放Latarjet手术，12例接受了关节镜下Bankart修复。25例中有24例（96%）的3-D CT扫描准确预测了进行关节镜下Bankart修复或开放Latarjet手术的关节镜决策（Fisher精确检验；P <.001）。
当使用0.75的基准值时，根据3-D CT扫描计算得出的关节盂指数准确预测了25例患者中24例（96%）进行骨移植手术的需求。因此，3-D CT扫描可被外科医生用作术前规划和患者咨询的额外诊断工具。
III级，具有普遍适用参考的诊断标准的制定（非连续患者）。
