Montgomery Scott R, Katthagen J Christoph, Mikula Jacob D, Marchetti Daniel Cole, Tahal Dimitri S, Dornan Grant J, Dahl Kimi D, Brady Alex W, Turnbull Travis Lee, Millett Peter J
Steadman Philippon Research Institute, Vail, Colorado, USA.
Franciscan Orthopedic Associates at St. Joseph, Tacoma, Washington, USA.
Am J Sports Med. 2017 May;45(6):1252-1260. doi: 10.1177/0363546516685318. Epub 2017 Feb 14.
The Latarjet procedure is commonly performed using either the classic or the congruent-arc technique. Each technique has potential clinical advantages and disadvantages. However, data on the anatomic and biomechanical effects, benefits, and limitations of each technique are limited. Hypothesis/Purpose: To compare the anatomy and biomechanical fixation strength (failure load) between the 2 techniques. It was hypothesized that the classic technique would have superior initial fixation when compared with the congruent-arc technique and that this would be affected by sex and coracoid size.
Controlled laboratory study.
A biomechanical cadaver study was performed with 20 pairs of male and female shoulders. One of each pair of shoulders was randomly assigned to receive the classic or congruent-arc technique. Coracoid and glenoid anatomic measurements were collected before biomechanical testing. A tensile force was applied through the conjoined tendon to replicate forces experienced by the coracoid graft in the early postoperative period, and the failure load was determined for each specimen.
The mean ± SD surface area available for fixation was 263 ± 63 mm in the classic technique compared with 177 ± 63 mm in the congruent-arc group ( P < .001). 36% of the glenoid width was recreated in the classic group and 50% in the congruent-arc group ( P < .001). The congruent-arc technique resulted in a significantly lower ( P = .005) mean failure load (239 ± 91 N) compared with the classic technique (303 ± 114 N). Failure load was significantly higher in males ( P = .037); male specimens had a mean failure load of 344 ± 122 N for the classic technique and 289 ± 73 N for the congruent-arc technique, and females had a mean failure load of 266 ± 98 N and 194 ± 84 N, respectively.
In this biomechanical model, the classic technique of the Latarjet procedure provided a greater surface area for healing to the glenoid and superior initial fixation when compared with the congruent-arc technique. The congruent-arc technique allowed restoration of a larger glenoid defect.
The classic and congruent-arc techniques of coracoid transfer have anatomic and biomechanical advantages and disadvantages that should be considered when choosing between the 2 techniques.
拉塔热手术通常采用经典技术或等弧技术进行。每种技术都有潜在的临床优缺点。然而，关于每种技术的解剖学和生物力学效应、益处及局限性的数据有限。假设/目的：比较两种技术之间的解剖结构和生物力学固定强度（破坏载荷）。假设经典技术与等弧技术相比，初始固定效果更好，且这会受到性别和喙突大小的影响。
对照实验室研究。
对20对男性和女性肩部进行生物力学尸体研究。每对肩部中的一个随机分配接受经典技术或等弧技术。在生物力学测试前收集喙突和关节盂的解剖学测量数据。通过联合肌腱施加拉力，以模拟术后早期喙突移植所承受的力，并确定每个标本的破坏载荷。
经典技术组可用于固定的平均表面积±标准差为263±63平方毫米，等弧技术组为177±63平方毫米（P <.001）。经典技术组重建了关节盂宽度的36%，等弧技术组为50%（P <.001）。与经典技术（303±114牛）相比，等弧技术的平均破坏载荷显著更低（P =.005）（239±91牛）。男性的破坏载荷显著更高（P =.037）；经典技术的男性标本平均破坏载荷为344±122牛，等弧技术为289±73牛，女性的平均破坏载荷分别为266±98牛和194±84牛。
在这个生物力学模型中，与等弧技术相比，拉塔热手术的经典技术为关节盂愈合提供了更大的表面积和更好的初始固定效果。等弧技术可修复更大的关节盂缺损。
喙突转移的经典技术和等弧技术具有解剖学和生物力学上的优缺点，在两种技术之间进行选择时应予以考虑。
