Gendre P, Thélu C-E, d'Ollonne T, Trojani C, Gonzalez J-F, Boileau P
Institut Universitaire Locomoteur et Sport, hôpital Pasteur 2, 30 Voie Romaine - CS 51069, 06001 Nice Cedex 1, France.
Clinique du Sport et de Chirurgie Orthopédique, 199 rue de la Rianderie, 59706 Marcq-en-Baroeul, France.
Orthop Traumatol Surg Res. 2016 Dec;102(8):983-987. doi: 10.1016/j.otsr.2016.06.016. Epub 2016 Oct 5.
The purpose of this study was to evaluate suture button fixation in a bone block (Bristow and Latarjet) procedure. We hypothesize that (1) cortical button fixation will allow predictable and reproducible bone union and (2) minimize the complications reported with screw fixation.
Seventy patients (mean age, 27 years) underwent an arthroscopic bone block procedure with a guided surgical approach and suture button fixation for recurrent anterior shoulder instability. There were two groups of patients: 35 Bristow procedures (group A) and 35 Latarjet procedures (group B). Bone graft union and positioning accuracy were assessed by postoperative computed tomography imaging at 2 weeks and 6 months, respectively.
The coracoid graft was positioned below the equator in 93% and strictly tangential to the glenoid surface in 94% of the cases. Bone healing was observed in 83% of the cases (58/70) with 74% bone union in group A and 91% in group B. Neurologic and hardware complications, classically reported with screw fixation, were not observed with this novel fixation method.
(1) Suture button fixation can be an alternative to screw fixation, obtaining bone block union, (2) in the lying position (Latarjet) bone healing was better than in the standing position (Bristow), and (3) complications classically reported with screw fixation were not observed.
Level IV.
本研究旨在评估骨块（布里斯托和拉塔热）手术中的缝线纽扣固定。我们假设：（1）皮质纽扣固定将实现可预测且可重复的骨愈合，以及（2）将螺钉固定所报告的并发症降至最低。
70例患者（平均年龄27岁）接受了关节镜下骨块手术，采用引导手术入路和缝线纽扣固定治疗复发性肩关节前脱位。患者分为两组：35例行布里斯托手术（A组）和35例行拉塔热手术（B组）。分别在术后2周和6个月通过计算机断层扫描成像评估骨移植愈合情况和定位准确性。
在93%的病例中，喙突移植骨位于赤道下方，在94%的病例中与关节盂表面严格相切。83%的病例（58/70）观察到骨愈合，A组骨愈合率为74%，B组为91%。这种新型固定方法未观察到螺钉固定经典报道的神经和硬件并发症。
（1）缝线纽扣固定可替代螺钉固定，实现骨块愈合；（2）卧位（拉塔热）骨愈合优于立位（布里斯托）；（3）未观察到螺钉固定经典报道的并发症。
四级。
