Capito Nicholas M, Owens Brett D, Sherman Seth L, Smith Matthew J
Brown University, Providence, Rhode Island.
University Orthopedics, Providence, Rhode Island.
JBJS Rev. 2016 Nov 15;4(11). doi: 10.2106/JBJS.RVW.16.00001.
The use of fresh osteochondral allografts has become popular in many joint-preserving orthopaedic procedures and shows early promising results within the shoulder. Distal tibial allograft contains a stout cartilaginous layer that appears to have highly congruent curvature and concavity to the glenoid, which makes for an optimal allograft option for instability. In the setting of large Hill-Sachs lesions, the use of a humeral-head osteochondral allograft is essential to restore geometry, stability, and mechanics of the native glenohumeral joint. One must be cautious with the treatment of glenoid chondral lesions with osteoarticular grafting procedures because of the depth of the glenoid compared with the depth of subchondral bone on the graft necessary to achieve a press fit, and advanced imaging is recommended when planning an operative intervention. Optimizing joint-preservation treatment with osteochondral allografts will rely on the long-term results of these procedures, and careful patient selection, preoperative discussion, and realistic expectations are necessary.
新鲜同种异体骨软骨移植在许多保关节骨科手术中已变得流行，并在肩部显示出早期的良好效果。胫骨远端异体骨包含一层厚实的软骨层，其曲率和凹陷似乎与肩胛盂高度一致，这使其成为治疗不稳定的理想异体骨选择。在存在大型Hill-Sachs损伤的情况下，使用肱骨头骨软骨异体移植对于恢复天然盂肱关节的几何形状、稳定性和力学性能至关重要。由于肩胛盂的深度与实现压配所需移植骨的软骨下骨深度相比，在采用骨关节移植手术治疗肩胛盂软骨损伤时必须谨慎，并且在计划手术干预时建议进行高级成像检查。利用骨软骨异体移植优化保关节治疗将依赖于这些手术的长期结果，并且需要仔细的患者选择、术前讨论和现实的期望。
