Mascarenhas Randy, Raleigh Eden, McRae Sheila, Leiter Jeff, Saltzman Bryan, MacDonald Peter B
University of Texas Health Sciences Center at Houston, Houston, TX, Australia.
City Orthopaedics, Melbourne, Australia.
Int J Shoulder Surg. 2014 Oct;8(4):127-32. doi: 10.4103/0973-6042.145269.
Performing a labral repair alone in patients with recurrent anterior instability and a large glenoid defect has led to poor outcomes. We present a technique involving the use of the iliac crest allograft inserted into the glenoid defect in athletes with recurrent anterior shoulder instability and large bony defects of the glenoid (>25% of glenoid diameter). All athletes with recurrent anterior shoulder instability and a large glenoid defect that underwent open anterior shoulder stabilization and glenoid reconstruction with the iliac crest allograft were followed over a 4-year period. Preoperatively, a detailed history and physical exam were obtained along with standard radiographs and magnetic resonance imaging of the affected shoulder. All patients also completed the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) evaluation forms preoperatively. A computed tomography scan was obtained postoperatively to assess osseous union of the graft and the patient again went through a physical exam in addition to completing the SST, ASES, and Western Ontario Shoulder Instability Index (WOSI) forms. 10 patients (9 males, 1 female) were followed for an average of 16 months (4-36 months) and had a mean age of 24.4 years. All patients exhibited a negative apprehension/relocation test and full shoulder strength at final follow-up. Eight of 10 patients had achieved osseous union at 6 months (80.0%). ASES scores improved from 64.3 to 97.8, and SST scores improved from 66.7 to 100. Average postoperative WOSI scores were 93.8%. The use of the iliac crest allograft provides a safe and clinically useful alternative compared to previously described procedures for recurrent shoulder instability in the face of glenoid deficiency.
对于复发性前向不稳且存在较大盂肱关节缺损的患者，单纯进行盂唇修复的效果不佳。我们介绍一种技术，即对于复发性前向肩不稳且盂肱关节存在较大骨质缺损（>盂肱关节直径的25%）的运动员，使用髂嵴异体骨植入盂肱关节缺损处。对所有接受开放性前肩稳定术及使用髂嵴异体骨进行盂肱关节重建的复发性前向肩不稳且存在较大盂肱关节缺损的运动员进行了为期4年的随访。术前，获取了详细的病史和体格检查结果，以及患侧肩部的标准X线片和磁共振成像。所有患者术前还完成了简易肩部测试（SST）和美国肩肘外科医师学会（ASES）评估表。术后进行了计算机断层扫描以评估移植物的骨愈合情况，患者除了完成SST、ASES和西安大略肩不稳指数（WOSI）表格外，还再次接受了体格检查。10例患者（9例男性，1例女性）平均随访了16个月（4 - 36个月），平均年龄为24.4岁。所有患者在末次随访时均表现为恐惧/复位试验阴性且肩部力量正常。10例患者中有8例在6个月时实现了骨愈合（80.0%）。ASES评分从64.3提高到97.8，SST评分从66.7提高到100。术后平均WOSI评分为93.8%。与先前描述的针对存在盂肱关节缺损的复发性肩不稳的手术方法相比，使用髂嵴异体骨提供了一种安全且临床有用的替代方法。
