Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
J Shoulder Elbow Surg. 2014 Nov;23(11):1700-8. doi: 10.1016/j.jse.2014.03.004. Epub 2014 Jun 12.
Open bone block procedures for glenohumeral stabilization have been used for a long time. With the advancement of arthroscopic techniques and the development of sophisticated instruments and implants, the insertion of the bone block can be performed by an all-arthroscopic approach. The purpose of this study was to evaluate the clinical and radiologic results after an arthroscopic anatomic glenoid reconstruction using an all-arthroscopic, autologous tricortical iliac crest bone grafting technique.
Fifteen patients (1 female and 14 male patients; mean age, 31.4 years [range, 17-49 years]) underwent reconstruction of significant glenoid defects in cases of recurrent shoulder instability by the aforementioned technique. The patients were followed up clinically (range of motion, Constant score, Rowe score, Subjective Shoulder Value, and Western Ontario Shoulder Instability Index) and radiographically (with true anteroposterior and axillary views, as well as 2-/3-dimensional computed tomography [glenoid configuration, signs of graft resorption, bone consolidation, and glenoid index]).
After a mean follow-up period of 20.6 months (range, 12-65 months), the Constant score averaged 85.0 points (range, 73-98 points; contralateral side, 89.6 points [range, 78-96 points]), the Rowe score averaged 88.0 points (range, 65-100 points), the Subjective Shoulder Value averaged 84.5% (range, 50%-100%), and the Western Ontario Shoulder Instability Index averaged 76.7% (range, 46%-93%). No recurrent subluxations or dislocations were observed. Radiographically, computed tomography imaging showed a consolidated autograft in all cases. The glenoid index increased from a mean of 0.77 preoperatively to 1.16 immediately postoperatively; at the time of last follow-up, the glenoid index decreased to 1.04.
The arthroscopic reconstruction of anteroinferior glenoid defects re-creates the pear-shaped anatomy of the anteroinferior glenoid and leads to good to excellent early clinical results.
开放骨块术式已被广泛用于治疗肩盂不稳定，随着关节镜技术的进步和复杂器械及植入物的发展，现在可通过全关节镜入路进行骨块植入。本研究旨在评估采用全关节镜下自体三叶形髂嵴骨移植技术进行关节镜下解剖性盂唇重建的临床和影像学结果。
15 例患者（1 例女性，14 例男性；平均年龄 31.4 岁[17-49 岁]）因复发性肩关节不稳定接受了上述技术的盂唇重建。通过临床（活动范围、Constant 评分、Rowe 评分、主观肩部值和 Western Ontario 肩不稳定指数）和影像学（前后位和腋位 X 线片，以及二维/三维 CT[盂唇形态、移植物吸收、骨整合和盂唇指数]）进行随访。
平均随访 20.6 个月（12-65 个月）后，Constant 评分为 85.0 分（73-98 分；对侧 89.6 分[78-96 分]），Rowe 评分为 88.0 分（65-100 分），主观肩部值为 84.5%（50%-100%），Western Ontario 肩不稳定指数为 76.7%（46%-93%）。无再发性半脱位或脱位。影像学检查显示所有病例均为骨移植物融合。盂唇指数由术前的 0.77 增加到术后即刻的 1.16，末次随访时下降至 1.04。
关节镜下重建盂唇前下缺损可重塑盂唇前下梨形解剖结构，获得良好至优秀的早期临床效果。
