Department of Orthopedic Surgery, Taipei Medical University Hospital, Taipei, Taiwan.
Am J Sports Med. 2009 Sep;37(9):1792-7. doi: 10.1177/0363546509334590. Epub 2009 May 29.
Severe glenoid bone loss in recurrent anterior glenohumeral instability is rare and difficult to treat.
The authors present a surgical technique using allogeneic bone grafting for open anatomic glenoid reconstruction in addition to the capsular shift procedure.
Case series; Level of evidence, 4.
Nine consecutive patients with a history of recurrent anterior shoulder instability underwent reconstruction of large bony glenoid erosion with a femoral head allograft combined with an anteroinferior capsular shift procedure. Preoperative computed tomographic and arthroscopic evaluation was performed to confirm a > or =120 degrees osseous defect of the anteroinferior quadrant of the glenoid cavity, which had an "inverted-pear" appearance. Patients were followed for at least 4.5 years (range, 4.5-14). Serial postoperative radiographs were evaluated. Functional outcomes were assessed using Rowe scores.
All grafts showed bony union within 6 months after surgery. The mean Rowe score improved to 84 from a preoperative score of 24. The mean loss of external rotation was 7 degrees compared with the normal shoulder. One subluxation and 1 dislocation occurred after grand mal seizures during follow-up. These 2 patients regained shoulder stability after closed reduction. The remaining patients did not report recurrent instability. All patients resumed daily activities without restricted motion.
This technique for open reconstruction is viable for the treatment of recurrent anterior glenohumeral instability with large bony glenoid erosion.
复发性前肩盂不稳定伴严重肩盂骨丢失罕见且难以治疗。
作者介绍了一种在囊袋移位术的基础上，使用同种异体骨移植进行开放式解剖肩盂重建的手术技术。
病例系列；证据等级，4 级。
9 例复发性前肩不稳定患者接受了同种异体股骨头移植联合前下囊袋移位术治疗大骨盂侵蚀。术前进行 CT 和关节镜评估，以确认盂前下象限有≥120°的骨缺损，呈现“倒梨”形。至少随访 4.5 年（范围 4.5-14 年）。随访时进行连续的术后影像学评估。使用 Rowe 评分评估功能结果。
所有移植物均在术后 6 个月内显示骨性愈合。Rowe 评分从术前的 24 分平均提高到 84 分。与正常肩相比，外旋平均丢失 7 度。在随访过程中，有 1 例大发作癫痫后出现半脱位，1 例出现脱位。这 2 例患者经闭合复位后恢复了肩关节稳定性。其余患者未报告复发性不稳定。所有患者均恢复日常活动，无运动受限。
这种开放式重建技术对于治疗伴有大骨盂侵蚀的复发性前肩盂不稳定是可行的。
