Aurich Matthias, Hofmann Gunther O, Gras Florian
Department of Orthopaedics and Trauma Surgery, Sana Kliniken Leipziger Land, Sana Klinikum Borna, Rudolf-Virchow-Str. 2, 04552, Borna, Germany.
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Erlanger Allee 101, Jena, 07747, Germany.
BMC Musculoskelet Disord. 2015 Sep 4;16:238. doi: 10.1186/s12891-015-0698-8.
The coracoacromial ligament (CAL) is an important restraint to superior shoulder translation. CAL release with the Latarjet procedure leads to increased superior humeral translation. Therefore, a surgical technique was developed to reconstruct the CAL during a modified Latarjet procedure.
Between May 2010 and July 2011, six patients (five were male, one was female; age 23-41 years) with chronic post-traumatic anterior shoulder instability were treated surgically with a modified congruent-arc Latarjet procedure (modLAT) with additional reconstruction of the CAL using a newly developed procedure, the pectoralis minor fascia flap (PMFF). Clinical follow-up was performed for up to 36 months, and patients were evaluated using a Rowe score.
All six patients experienced chronic, post-traumatic anterior shoulder instability and had experienced multiple re-dislocations after initial treatment. The preoperative assessment showed a defect of the anterior glenoid in three cases, and the mean Rowe score was 16.67 (5-25). Open modLAT with PMFF resulted in a stable shoulder function with no re-dislocations. The Rowe score increased from 77.5 (65-90) at 12 weeks to 95 (90-100) at 12 months and plateaued thereafter. Operative duration was 95 min (78-112 min), and there were no intra- or postoperative complications. All patients returned to their preoperative sports activity, three at the same level.
The PMFF is a safe technique for reconstruction of the CAL during a modLAT procedure. Patients had improved shoulder function and no re-dislocations after the surgery.
喙肩韧带（CAL）是限制肩关节向上移位的重要结构。在Latarjet手术中松解CAL会导致肱骨头向上移位增加。因此，开发了一种手术技术，在改良Latarjet手术过程中重建CAL。
2010年5月至2011年7月期间，对6例（5例男性，1例女性；年龄23 - 41岁）慢性创伤后肩关节前向不稳患者采用改良全等弧Latarjet手术（modLAT）联合一种新开发的技术——胸小肌筋膜瓣（PMFF）重建CAL进行手术治疗。进行了长达36个月的临床随访，并使用Rowe评分对患者进行评估。
所有6例患者均有慢性创伤后肩关节前向不稳，初始治疗后均经历多次再脱位。术前评估显示3例存在前盂肱关节缺损，平均Rowe评分为16.67（5 - 25）。采用PMFF的开放modLAT手术使肩关节功能稳定，无再脱位发生。Rowe评分从12周时的77.5（65 - 90）提高到12个月时的95（90 - 100），此后趋于稳定。手术时间为95分钟（78 - 112分钟），无术中或术后并发症。所有患者均恢复到术前的体育活动水平，3例恢复到相同水平。
PMFF是在modLAT手术中重建CAL的一种安全技术。患者术后肩关节功能改善，无再脱位发生。
