Jinzhong Zhao, Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, 600 Yishan Road, Shanghai 200233, China.
Am J Sports Med. 2014 Apr;42(4):831-9. doi: 10.1177/0363546513519227. Epub 2014 Feb 7.
The healing rate and clinical outcomes of glenoid bone grafting with nonrigid fixation for patients with recurrent anterior shoulder instability are unknown.
Glenoid bone grafting with nonrigid fixation can yield satisfactory results for patients with recurrent anterior shoulder instability with regard to graft healing and the restoration of shoulder stability.
Case series; Level of evidence, 4.
A total of 52 patients with recurrent anterior shoulder instability underwent Bankart or bony Bankart repair as well as arthroscopic glenoid bone grafting. Allogenic bicortical iliac grafts were used. Instead of firm fixation, the grafts were tethered to the glenoid by sutures from anchors placed in the glenoid surface. Follow-up occurred at 3, 6, 12, and 24 months. Computed tomography and magnetic resonance imaging examinations were performed immediately after surgery and at each follow-up visit to evaluate the healing of the graft and the changes in the repaired capsule-labrum structure. Functional evaluations were taken at 24 months with the Oxford Shoulder Instability Score and the Rowe Score for Shoulder Instability. For the patients who underwent surgery 2.5 years earlier, an additional review was conducted to evaluate the latest stability status of the shoulder. Failure was defined as recurrence of dislocation or instability.
The mean follow-up time was 39 months (range, 24-64 months). In all cases, the grafts healed to the glenoid at 3 or 6 months, and glenoid remodeling was complete within 12 months; in most cases, a robust bone-capsule structure formed on the anterior side of the glenoid. The glenoid defect area changed from 32.7% ± 8.7% (range, 10.7% to 53.9%) to -16.3% ± 3.3% (range, -26.7% to 5.9%), and the glenoid defect width changed from 28.3% ± 8.7% (range, 10.4% to 54.5%) to -16.9% ± 7.3% (range, -33.4% to 2.8%). Compared with the presumed normal glenoid, the final glenoid surface area increased in 94.2% of patients and final glenoid width increased in 96.2% of patients. One patient experienced redislocation and 2 experienced a sense of instability without dislocation, which resulted in a failure rate of 5.8%. Six patients exhibited slight pain. The Oxford score improved from 29.7 ± 5.6 preoperatively to 42.4 ± 3.3 at 2 years postoperatively, and the Rowe score improved from 34.7 ± 6.1 preoperatively to 91.8 ± 2.8 at 2 years postoperatively.
In this study, arthroscopic glenoid bone grafting with nonrigid fixation in combination with Bankart repair resulted in 100% graft healing and the satisfactory restoration of shoulder stability.
对于复发性肩关节前不稳定患者，采用非刚性固定的盂骨植骨术的愈合率和临床结果尚不清楚。
对于复发性肩关节前不稳定患者，采用非刚性固定的盂骨植骨术可获得满意的结果，包括移植物愈合和肩关节稳定性的恢复。
病例系列；证据水平，4 级。
52 例复发性肩关节前不稳定患者接受 Bankart 或骨性 Bankart 修复术以及关节镜下盂骨植骨术。使用同种异体双皮质髂骨移植物。移植物通过缝合线固定在盂骨上，而不是用坚固的固定物固定，缝合线来自放置在盂骨表面的锚钉。在术后 3、6、12 和 24 个月进行随访。术后立即以及每次随访时进行计算机断层扫描和磁共振成像检查，以评估移植物的愈合情况以及修复的囊-盂唇结构的变化。在术后 24 个月时使用牛津肩不稳定评分和肩不稳定的 Rowe 评分进行功能评估。对于 2.5 年前接受手术的患者，进行了额外的回顾性评估，以评估肩部的最新稳定性状况。失败的定义为复发性脱位或不稳定。
平均随访时间为 39 个月（范围，24-64 个月）。在所有病例中，移植物在 3 或 6 个月时与盂骨愈合，盂骨重塑在 12 个月内完全完成；在大多数情况下，盂骨的前侧形成了一个坚固的骨-囊结构。盂骨缺损面积从 32.7%±8.7%（范围，10.7%至 53.9%）变为-16.3%±3.3%（范围，-26.7%至 5.9%），盂骨缺损宽度从 28.3%±8.7%（范围，10.4%至 54.5%）变为-16.9%±7.3%（范围，-33.4%至 2.8%）。与假定的正常盂骨相比，94.2%的患者最终盂骨表面积增加，96.2%的患者最终盂骨宽度增加。1 例患者出现再脱位，2 例患者出现无脱位的不稳定感，失败率为 5.8%。6 例患者出现轻微疼痛。术后 2 年牛津评分从术前的 29.7±5.6 提高至 42.4±3.3，Rowe 评分从术前的 34.7±6.1 提高至 91.8±2.8。
在本研究中，采用非刚性固定的关节镜下盂骨植骨术联合 Bankart 修复术可实现 100%的移植物愈合和满意的肩关节稳定性恢复。
