Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Sea to Sky Orthopaedics, Squamish General Hospital & Whistler Health Care Centre, PO Box 1275, Whistler, BC, V0N 1B0, Canada.
Clin Orthop Relat Res. 2013 Aug;471(8):2548-55. doi: 10.1007/s11999-013-3024-5. Epub 2013 May 8.
The Weber derotation osteotomy is an uncommon procedure that typically is reserved for patients with engaging Hill-Sachs defects who have had other surgical treatments for shoulder instability fail. It is unknown whether the desired humeral derotation actually is achieved with the Weber osteotomy.
QUESTIONS/PURPOSES: The purposes of this study were to answer the following questions: (1) What are the complication (including redislocation) and reoperation rates of the Weber osteotomy? (2) What are the American Shoulder and Elbow Surgeons (ASES) and functional (ROM in internal rotation, self care) results? (3) What fraction of the patients had humeral derotation within 10° of the desired rotation?
A chart review of 19 Weber osteotomies and clinical assessment of 10 Weber osteotomies were performed by independent clinicians. The chart review, at a mean followup of 51 months (range, 13-148 months), focused on the complication rate and the frequency of redislocation. The clinical and CT assessments, at a mean followup of 54 months (range, 26-151 months), focused on ASES scores, ability of patients to perform self care with the affected arm, and CT scans to measure change in humeral retroversion.
There were 25 complications and nine reoperations in 17 patients (19 shoulders), including pain (six patients, of whom one had complex regional pain syndrome), hematoma, infection, nonunion, delayed union, reoperations related to hardware and other noninstability-related causes (five patients), and internal rotation deficit. Redislocation occurred in one patient, who underwent repeat surgery, and subjective instability developed in two others. The mean ASES score was 78 points (of 100 points); six of the 10 patients (11 procedures) evaluated in person found it difficult or were unable to wash their backs with the affected arm. Humeral derotation varied from 7° to 77°; only three of the nine patients for whom CT scans were available had derotation within 10° of the desired rotation.
Complication rates with the Weber osteotomy were much higher than previously reported. Because seven of 17 patients were lost to followup, the redislocation rate may be higher than we observed here. Given the unpredictable variability in humeral derotation achieved with a Weber osteotomy, an improved surgical technique is critical to avoid osteoarthritis and loss of internal rotation associated with overrotation.
Weber 旋转移位截骨术是一种不常见的手术，通常仅用于 Hill-Sachs 缺损伴肩锁关节不稳的患者，且其他手术治疗失败。目前尚不清楚 Weber 截骨术是否能真正实现肱骨的旋转移位。
问题/目的：本研究旨在回答以下问题：（1） Weber 截骨术的并发症（包括再脱位）和再次手术的发生率是多少？（2）美国肩肘外科医师学会（ASES）评分和功能（内旋活动度、自理能力）结果如何？（3）有多少患者的肱骨旋转达到了预期的 10°以内？
通过独立临床医生对 19 例 Weber 截骨术进行了图表回顾和 10 例 Weber 截骨术的临床评估。图表回顾在平均随访 51 个月（范围 13-148 个月）时，重点关注并发症发生率和再脱位频率。临床和 CT 评估在平均随访 54 个月（范围 26-151 个月）时，重点关注 ASES 评分、患者使用患侧手臂进行自理活动的能力以及 CT 扫描测量肱骨后旋的变化。
17 例患者（19 个肩）中有 25 例并发症和 9 例再次手术，包括疼痛（6 例，其中 1 例为复杂性区域疼痛综合征）、血肿、感染、骨不连、延迟愈合、与内固定物相关或与不稳定无关的其他原因的再次手术（5 例）以及内旋受限。1 例患者发生再脱位，再次手术；另有 2 例患者出现主观不稳定。平均 ASES 评分为 78 分（满分 100 分）；10 例患者中 6 例（11 例手术）在亲自评估时发现难以或无法用患侧手臂洗澡。肱骨旋转范围为 7°-77°；9 例中有 CT 扫描的患者中，只有 3 例的旋转达到了预期的 10°以内。
Weber 截骨术的并发症发生率远高于先前报道。由于 17 例患者中有 7 例失访，再脱位率可能高于我们观察到的结果。鉴于 Weber 截骨术实现的肱骨旋转存在不可预测的变化，因此需要改进手术技术，以避免与过度旋转相关的关节炎和内旋丧失。
