Kordasiewicz Bartłomiej, Małachowski Konrad, Kicinski Maciej, Chaberek Sławomir, Pomianowski Stanisław
SPSK im. A. Grucy, Otwock, Trauma and Orthopedics Department, Centre of Postgraduate Medical Education, Warsaw, Poland.
Int Orthop. 2017 May;41(5):1023-1033. doi: 10.1007/s00264-016-3372-3. Epub 2016 Dec 30.
The aim of this study was to compare early clinical results after open and arthroscopic Latarjet stabilisation in anterior shoulder instability. Our hypothesis was the results of arthroscopic stabilisation were comparable with the results of open procedure.
The clinical results of the patients after primary Latarjet procedure were analysed. Patients operated on between 2006 and 2011 using an open technique composed the OPEN group and patients operated on arthroscopically between 2011 and 2013 composed the ARTHRO group; 48 out of 55 shoulders (87%) in OPEN and 62 out of 64 shoulders (97%) in ARTHRO were available to follow-up. The average age at surgery was 28 years in OPEN and 26 years in ARTHRO. The mean follow-up was 54.2 months in OPEN and 23.4 months in ARTHRO. Intra-operative data were analysed regarding time of surgery, concomitant lesions and complications. Patient results were assessed with Walch-Duplay, Rowe, VAS scores and subjective self-evaluation of satisfaction and shoulder function. Computed tomography scan evaluation was used to assess the graft healing.
Average time of surgery was significantly shorter in ARTHRO than OPEN: respectively 110 and 120 minutes. The number of intra-operative complications was six (12.5%) in OPEN and five (8.1%) in ARTHRO. The results were comparable in both groups, with no significant difference between OPEN and ARTHRO group: satisfaction rate - 96.8% and 91.9%, shoulder function - 92.2% and 90%, Walch-Duplay score - 83.9 and 76.7 respecively. A significant difference was reported in Rowe score: 87.8 in OPEN and 78.9 in ARTHRO. Another significant difference was found in the presence of "subjective apprehension"-a term referring to the subjective perception of instability with no signs of instability at clinical examination - 28.7% in OPEN and 50% in ARTHRO. Range of motion in both groups were comparable, however patients in OPEN had significantly lower loss of external rotation in adduction to the side comparing to the contralateral shoulder: 7° versus 14° in ARTHRO. Recurrence was reported in three cases in each group: 6.2% in OPEN and 4.8% in ARTHRO. A revision surgery was performed in four patients (9.3%) in OPEN and six (9.7%) in ARTHRO. Radiographic evaluation showed a significantly lower rate (5%) of graft healing problems (fracture, non-union and osteolysis) after arthroscopic stabilisation, however a partial osteolysis of the proximal part of the bone block was significantly more frequent (53.5%).
The arthroscopic Latarjet stabilisation showed satisfactory and comparable results to open procedure. We recommend further investigation and development of arthroscopic technique.
III.
本研究旨在比较开放性和关节镜下Latarjet手术治疗前肩不稳的早期临床结果。我们的假设是关节镜下稳定手术的结果与开放手术的结果相当。
分析初次Latarjet手术后患者的临床结果。2006年至2011年采用开放技术手术的患者组成开放组，2011年至2013年关节镜下手术的患者组成关节镜组；开放组55例肩部患者中有48例（87%）、关节镜组64例肩部患者中有62例（97%）可进行随访。开放组手术平均年龄为28岁，关节镜组为26岁。开放组平均随访时间为54.2个月，关节镜组为23.4个月。分析术中数据，包括手术时间、合并损伤和并发症。采用Walch-Duplay、Rowe、视觉模拟评分（VAS）以及满意度和肩部功能的主观自我评价来评估患者结果。使用计算机断层扫描评估移植物愈合情况。
关节镜组的平均手术时间明显短于开放组，分别为110分钟和120分钟。开放组术中并发症有6例（12.5%），关节镜组有5例（8.1%）。两组结果相当，开放组和关节镜组之间无显著差异：满意度分别为96.8%和91.9%，肩部功能分别为92.2%和90%，Walch-Duplay评分分别为83.9和76.7。Rowe评分有显著差异：开放组为87.8，关节镜组为78.9。另一个显著差异在于“主观恐惧”的存在——该术语指临床检查无不稳定体征时的不稳定主观感觉，开放组为28.7%，关节镜组为50%。两组的活动范围相当，但开放组患者内收时患侧与对侧肩部相比外旋丧失明显更低：关节镜组为14°，开放组为7°。每组均有3例复发：开放组为6.2%，关节镜组为4.8%。开放组有4例患者（9.3%）进行了翻修手术，关节镜组有6例（9.7%）。影像学评估显示关节镜下稳定手术后移植物愈合问题（骨折、不愈合和骨质溶解）的发生率显著更低（5%），然而骨块近端部分的部分骨质溶解明显更常见（53.5%）。
关节镜下Latarjet稳定手术显示出与开放手术相当且令人满意的结果。我们建议进一步研究和发展关节镜技术。
III级
