Hart R, Sváb P, Krejzla J
Ortopedicko-traumatologické oddelení Nemocnice Znojmo.
Acta Chir Orthop Traumatol Cech. 2010 Apr;77(2):105-11.
The aim of this prospective study was to report on an open approach to a bony defect of the glenoid associated with anterior shoulder instability, using a modified Latarjet procedure, in elderly patients.
From 2003 to 2005, 11 patients older than 50 years underwent an open Latarjet procedure performed by two senior surgeons. The mean age of the patients was 65 years (range, 51 to 79 years). All of them were available for follow-up examination. There were seven women and four men. The study inclusion criteria were a bony defect of the anterior glenoid confirmed by a CT scan, age over 50 years, and three or more previous dislocations.The mean pre-operative forward elevation was 121.2 degrees+/-16.6 degrees (range, 40 degrees-180 degrees) and external rotation was 43.3 degrees+/-13.1 degrees (range, 5 degrees-80 degrees). The mean number of dis- locations before surgery was 4.8 (range, 3-8).
The Latarjet operation makes use of a large coracoid bone graft to extend the glenoid articular surface by means of a lengthened bone platform, and a sling effect of the conjoined tendon passing through the subscapularis muscle. The Constant-Murley score was used to evaluate the results.
Shoulder stability and function were restored in all 11 patients at a minimum follow-up of 4 years (range, 49-69 months). There was no recurrence of instability. The range of motion was minimally reduced; the mean loss of elevation was 18.8 degrees and the mean loss of external rotation was 4.0 degrees. The mean Constant-Murley score increased from 56.4+/-13.3 points preoperatively to 81.8+/-11.3 points post-operatively (p<0.05). No significant post-operative complications were observed.
It is necessary to differentiate between the Latarjet procedure and its modification popularised by Helfet as the Bristow or the Bristow-Latarjet operation. The Bristow procedure transfers only the tip of the coracoid, along with the attached con- joined tendon, to the anterior side of the neck. This procedure does not treat the bony defect and provides a mere soft-tis- sue constraint. Only a few reports of the original Latarjet procedure can be found in the international literature.
The open Latarjet reconstruction can successfully restore shoulder stability in joints with a significant bony defect of the glenoid even in elderly patients. It is effective in situations in which soft-tissue reconstruction is not a reasonable option.
本前瞻性研究旨在报告一种针对老年患者因前肩不稳伴发的肩胛盂骨缺损采用改良Latarjet手术的开放入路方法。
2003年至2005年，11例年龄超过50岁的患者接受了由两位资深外科医生实施的开放性Latarjet手术。患者的平均年龄为65岁（范围51至79岁）。所有患者均接受了随访检查。其中有7名女性和4名男性。研究纳入标准为经CT扫描证实的肩胛盂前部骨缺损、年龄超过50岁以及既往有三次或更多次脱位。术前平均前屈抬高角度为121.2度±16.6度（范围40度至180度），外旋角度为43.3度±13.1度（范围5度至80度）。术前脱位的平均次数为4.8次（范围3至8次）。
Latarjet手术利用一块大的喙突骨块，通过延长的骨平台来扩展肩胛盂关节面，并利用穿过肩胛下肌的联合肌腱的悬吊作用。采用Constant-Murley评分来评估结果。
11例患者在至少4年（范围49至69个月）的随访中，肩部稳定性和功能均得以恢复。未出现不稳定复发情况。活动范围仅有轻微减小；抬高角度平均损失18.8度，外旋角度平均损失4.0度。Constant-Murley评分术前平均为56.4±13.3分，术后升至81.8±11.3分（p<0.05）。未观察到明显的术后并发症。
有必要区分Latarjet手术及其由Helfet推广的改良术式（即Bristow术式或Bristow-Latarjet手术）。Bristow手术仅将喙突尖端连同附着的联合肌腱转移至颈部前方。该手术无法治疗骨缺损，仅提供软组织约束。国际文献中仅能找到少数关于原始Latarjet手术的报告。
开放性Latarjet重建术即使对于老年患者，也能成功恢复存在明显肩胛盂骨缺损的关节的肩部稳定性。在软组织重建并非合理选择的情况下，该方法有效。
