Chaudhary Deepak, Goyal Ankit, Joshi Deepak, Jain Vineet, Mohindra Mukul, Mehta Nitin
Director, Sports Injury Center, Safdarjung Hospital and VMM College, New Delhi, India.
Assistant Professor, Sports Injury Center, Safdarjung Hospital and VMM College, New Delhi, India.
J Clin Orthop Trauma. 2016 Jan-Mar;7(1):23-9. doi: 10.1016/j.jcot.2015.09.002. Epub 2015 Oct 21.
Technical faults leading to coracoid fractures during screw insertion and coracoid graft osteolysis are concerns with standard screw fixation techniques in Latarjet procedure. The purpose of this study is to share our experience using Arthrex wedge profile plate with mini-open technique for graft fixation, that ensures better load distribution between coracoid graft and glenoid.
We did retrospective analysis of 24 patients with recurrent anterior shoulder instability after failed arthroscopic Bankart's repair. Arthroscopic examination of affected shoulder was done in lateral position before making patient supine for open Latarjet. A low profile wedge plate (Arthrex) with two screws was used for the procedure. CT analysis was performed post-operatively at 6 months to see graft union and results were evaluated using the Rowe and Walch Duplay score.
Mean follow-up time was 26 months. Postoperatively, mean forward elevation was 170.6 + 4.6° (loss of average 5.9°) and mean external rotation was 42.5 + 5.3° (loss of average 3.1°). All patients returned to their previous occupation. None reported to be having any recurrent subluxation. Functional assessment done using Rowe score and Walch Duplay score showed statistically significant improvement (p value 0.034). There were no implant-related complications and no case of coracoid graft osteolysis.
Mini-open Latarjet with graft fixation with Arthrex mini-plate provides satisfactory outcome in patients who require reoperation due to dramatic bone loss and failed soft tissue reconstruction. The modified incision improves exposure enabling plate fixation and the secure fixation accelerates rehabilitation.
在拉塔热手术中，螺钉插入过程中导致喙突骨折以及喙突移植骨骨溶解的技术故障是标准螺钉固定技术所关注的问题。本研究的目的是分享我们使用Arthrex楔形钢板结合小切口技术进行移植骨固定的经验，该技术可确保喙突移植骨与关节盂之间更好的负荷分布。
我们对24例关节镜下Bankart修复失败后复发性前肩不稳的患者进行了回顾性分析。在患者仰卧进行开放性拉塔热手术之前，先在侧卧位对患肩进行关节镜检查。手术中使用带有两枚螺钉的低轮廓楔形钢板（Arthrex）。术后6个月进行CT分析以观察移植骨愈合情况，并使用Rowe和Walch Duplay评分对结果进行评估。
平均随访时间为26个月。术后，平均前屈上举角度为170.6 + 4.6°（平均丧失5.9°），平均外旋角度为42.5 + 5.3°（平均丧失3.1°）。所有患者均恢复了之前的工作。无一例报告有复发性半脱位。使用Rowe评分和Walch Duplay评分进行的功能评估显示有统计学意义的改善（p值0.034）。没有与植入物相关的并发症，也没有喙突移植骨骨溶解的病例。
采用Arthrex微型钢板进行移植骨固定的小切口拉塔热手术，对于因严重骨质流失和软组织重建失败而需要再次手术的患者可提供满意的结果。改良切口改善了暴露情况，便于钢板固定，而牢固的固定加速了康复进程。
