Degen Ryan M, Giles Joshua W, Johnson James A, Athwal George S
Hand and Upper Limb Biomechanics Laboratory, St Joseph's Health Care, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada.
Clin Orthop Relat Res. 2014 Aug;472(8):2363-71. doi: 10.1007/s11999-013-3436-2. Epub 2014 Jan 3.
Recurrent shoulder instability is commonly associated with Hill-Sachs defects. These defects may engage the glenoid rim, contributing to glenohumeral dislocation. Two treatment options to manage engaging Hill-Sachs defects are the remplissage procedure, which fills the defect with soft tissue, and the Latarjet procedure, which increases glenoid arc length. Little evidence exists to support one over the other.
QUESTIONS/PURPOSES: We performed a biomechanical comparison of the remplissage procedure to the traditional Latarjet coracoid transfer for management of engaging Hill-Sachs defects in terms of joint stiffness (resistance to anterior translation), ROM, and frequency of dislocation.
Eight cadaveric specimens were tested on a shoulder instability simulator. Testing was performed with a 25% Hill-Sachs defect with an intact glenoid and after remplissage and Latarjet procedures. Joint stiffness, internal-external rotation ROM, and frequency of dislocation were assessed. Additionally, horizontal extension ROM was measured in composite glenohumeral abduction.
After remplissage, stiffness increased in adduction with neutral rotation (12.7 ± 3.7 N/mm) relative to the Hill-Sachs defect state (8.7 ± 3.3 N/mm; p = 0.016). The Latarjet procedure did not affect joint stiffness (p = 1.0). Internal-external rotation ROM was reduced in abduction after the Latarjet procedure (49° ± 14°) compared with the Hill-Sachs defect state (69° ± 17°) (p = 0.009). Horizontal extension was reduced after remplissage (16° ± 12°) relative to the Hill-Sachs defect state (34° ± 8°) (p = 0.038). With the numbers available, there was no difference between the procedures in terms of the frequency of dislocation after reconstruction: 84% of specimens (27 of 32 testing scenarios) stabilized after remplissage, while 94% of specimens (30 of 32 testing scenarios) stabilized after the Latarjet procedure.
Both procedures proved effective in reducing the frequency of dislocation in a 25% Hill-Sachs defect model, while neither procedure consistently altered joint stiffness.
In the treatment of shoulder instability with a humeral head bone defect and an intact glenoid rim, this study supports the use of both the remplissage and Latarjet procedures. Clinical studies and larger cadaveric studies powered to detect differences in instability rates are needed to evaluate these procedures in terms of their comparative efficacy at preventing dislocation, as any differences between them seem likely to be small.
复发性肩关节不稳定通常与希尔-萨克斯损伤有关。这些损伤可能会与关节盂边缘嵌合，导致盂肱关节脱位。处理嵌合性希尔-萨克斯损伤的两种治疗选择是 remplissage 手术，即用软组织填充损伤处，以及拉塔热手术，即增加关节盂弧长。几乎没有证据支持其中一种手术优于另一种。
问题/目的：我们对 remplissage 手术和传统的拉塔热喙突转移术进行了生物力学比较，以评估在处理嵌合性希尔-萨克斯损伤时，二者在关节僵硬程度（抵抗向前平移的能力）、活动度和脱位频率方面的差异。
在肩关节不稳定模拟器上对 8 个尸体标本进行测试。测试在存在 25% 希尔-萨克斯损伤且关节盂完整的情况下进行，以及在进行 remplissage 手术和拉塔热手术后进行。评估关节僵硬程度、内外旋转活动度和脱位频率。此外，在复合盂肱关节外展时测量水平伸展活动度。
与希尔-萨克斯损伤状态（8.7 ± 3.3 N/mm；p = 0.016）相比，remplissage 手术后，在内收且中立旋转时僵硬程度增加（12.7 ± 3.7 N/mm）。拉塔热手术未影响关节僵硬程度（p = 1.0）。与希尔-萨克斯损伤状态（69° ± 17°）相比，拉塔热手术后外展时的内外旋转活动度降低（49° ± 14°）（p = 于希尔-萨克斯损伤状态（34° ± 8°）（p = 0.038）。就现有数据而言，重建后脱位频率在两种手术之间没有差异：remplissage 手术后 84% 的标本（32 个测试场景中的 27 个）稳定，而拉塔热手术后 94% 的标本（32 个测试场景中的 30 个）稳定。
在 25% 希尔-萨克斯损伤模型中，两种手术在降低脱位频率方面均被证明有效，但两种手术均未持续改变关节僵硬程度。
在治疗伴有肱骨头骨缺损且关节盂边缘完整的肩关节不稳定时，本研究支持使用 remplissage 手术和拉塔热手术。需要进行临床研究和更大规模的尸体研究以检测不稳定率差异，从而根据它们在预防脱位方面的相对疗效来评估这些手术，因为它们之间的任何差异可能都很小。 0.009）。与希尔-萨克斯损伤状态相比，remplissage 手术后水平伸展降低（16° ± 12°）相
