Provencher Matthew T, Frank Rachel M, Golijanin Petar, Gross Daniel, Cole Brian J, Verma Nikhil N, Romeo Anthony A
The Steadman Clinic and Steadman Philippon Research Institute, Vail, Colorado, U.S.A..
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
Arthroscopy. 2017 May;33(5):891-897. doi: 10.1016/j.arthro.2016.09.029. Epub 2016 Dec 22.
To assess the clinical and radiographic outcomes of patients with recurrent anterior shoulder instability treated with fresh distal tibia allograft (DTA) glenoid reconstruction.
Consecutive patients with a minimum 15% anterior glenoid bone loss associated with recurrent anterior instability who underwent stabilization with DTA glenoid reconstruction were retrospectively reviewed. Patients were evaluated with the American Shoulder and Elbow Society score, Western Ontario shoulder instability index, and single numerical assessment evaluation score at a minimum 2 years after surgery. All patients also underwent postoperative imaging evaluation with computed tomography where graft incorporation and allograft angle were measured. Statistical analysis was performed with paired t-tests, with P < .05 considered significant.
A total of 27 patients (100% male) with an average age of 31 ± 5 years and an average follow-up of 45 months (range, 30-66) were included. There were significant improvements in preoperative to postoperative American Shoulder and Elbow Society score (63-91, P < .01), Western Ontario shoulder instability index (46% to 11% of normal, P < .01), and single numerical assessment evaluation score (50-90.5, P < .01) outcomes. Analysis of computed tomography data at an average 1.4 years postoperatively (available for 25 patients) showed an allograft healing rate of 89% (range, 80% to 100%), average allograft angle of 14.9° (range, 6.6° to 29.3°), and average allograft lysis of 3% (range, 0% to 25%). Grafts with lesser allograft angles (<15°) were better opposed to the anterior glenoid, showing superior healing and graft incorporation. There were no cases of recurrent instability.
At an average follow-up of 45 months, fresh DTA reconstruction for recurrent anterior shoulder instability results in a clinically stable joint with excellent clinical outcomes and minimal graft resorption. Optimal allograft placement resulted in superior bony incorporation with the native glenoid.
Level IV, therapeutic case series.
评估采用新鲜胫骨远端同种异体骨（DTA）盂唇重建治疗复发性前肩不稳患者的临床和影像学结果。
回顾性分析连续接受DTA盂唇重建稳定手术的、伴有复发性前不稳且前盂唇骨丢失至少15%的患者。术后至少2年时，采用美国肩肘协会评分、西 Ontario 肩不稳指数和单数字评估评分对患者进行评估。所有患者术后均接受计算机断层扫描成像评估，测量移植物融合情况和同种异体骨角度。采用配对t检验进行统计分析，P <.05为差异有统计学意义。
共纳入27例患者（100%为男性），平均年龄31±5岁，平均随访45个月（范围30 - 66个月）。术前至术后美国肩肘协会评分（63 - 91分，P <.01）、西 Ontario 肩不稳指数（从正常的46%降至11%，P <.01）和单数字评估评分（50 - 90.5分，P <.01）结果均有显著改善。术后平均1.4年（25例患者可获得数据）的计算机断层扫描数据分析显示，同种异体骨愈合率为89%（范围8
