Alps Surgery Institute, Clinique Générale d'Annecy, 4 Chemin de la Tour la Reine, Annecy, France.
J Shoulder Elbow Surg. 2013 Aug;22(8):1092-101. doi: 10.1016/j.jse.2012.09.011. Epub 2013 Jan 20.
Posterior instability is a relatively rare and challenging condition to treat. Soft-tissue procedures do not always provide satisfactory results. We present the results after arthroscopic posterior bone block augmentation with an iliac crest bone graft and a minimum of 12 months' follow-up.
Between 2008 and 2009, we performed 19 arthroscopic posterior bone blocks on 18 patients with posterior instability (bilaterally in 1 patient). The mean age was 29.85 years at the time of surgery. The mean follow-up was 20.5 months. All patients had a painful, unstable shoulder. Preoperative etiology included trauma, glenoid dysplasia, Ehlers-Danlos syndrome, and arthrosis with posterior glenoid erosion.
The Rowe score improved from 18.4 points to 82.1 points, and the Walch-Duplay score improved from 37.4 points to 82.9 points, both statistically significant (P < .01). Radiologic bone healing was achieved in all cases. Nine cases had an excellent result with return to the previous level of sports, six were satisfied, and three had a persistently painful shoulder. Subsequent removal of screws improved symptoms in two of these patients, and in one patient, a cause for the pain and persistent instability was not found.
Arthroscopic posterior bone block augmentation presents a reliable technique for the treatment of symptomatic posterior instability with varying origin. Although this is a technically demanding procedure, in our experience, the potential benefits and minimally invasive nature outweigh the risks and benefits of more invasive procedures.
后向不稳定是一种相对罕见且具有挑战性的疾病，软组织手术并不总是能提供满意的效果。我们介绍了采用髂嵴骨移植物进行关节镜后骨块增强术并进行至少 12 个月随访的结果。
在 2008 年至 2009 年期间，我们对 18 例后向不稳定的患者（1 例双侧）进行了 19 例关节镜后骨块增强术。手术时的平均年龄为 29.85 岁。平均随访时间为 20.5 个月。所有患者均有疼痛性、不稳定的肩部。术前病因包括创伤、肩胛盂发育不良、埃勒斯-当洛斯综合征和伴后肩胛盂侵蚀的关节炎。
Rowe 评分从 18.4 分提高到 82.1 分，Walch-Duplay 评分从 37.4 分提高到 82.9 分，均有统计学意义（P <.01）。所有病例均获得影像学骨愈合。9 例结果优秀，恢复到以前的运动水平，6 例满意，3 例肩部持续疼痛。随后取出螺钉改善了其中 2 例患者的症状，在 1 例患者中，未找到导致疼痛和持续不稳定的原因。
关节镜后骨块增强术是治疗不同病因引起的有症状后向不稳定的可靠技术。尽管这是一项技术要求较高的手术，但根据我们的经验，其潜在的益处和微创性超过了更具侵入性手术的风险和益处。
