Katthagen J Christoph, Anavian Jack, Tahal Dimitri S, Millett Peter J
Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
The Steadman Clinic, Vail, Colorado, U.S.A.
Arthrosc Tech. 2016 Oct 10;5(5):e1135-e1141. doi: 10.1016/j.eats.2016.06.006. eCollection 2016 Oct.
Bipolar bone loss in patients with anterior glenohumeral instability is challenging to treat. The goal of the treatment is to restore stability by ensuring that the humeral head remains within the glenoid vault. This can be achieved either with the combination of an arthroscopic Bankart procedure and remplissage (glenoid bone loss <25%), or with a Latarjet procedure (glenoid bone loss >25%). In cases with more severe bipolar bone loss of both the glenoid and the humeral head, the conventional approach has been to lengthen the articular arc of the glenoid and to ignore the Hill-Sachs lesion. However, it has recently been shown that this can still lead to an "off-track" situation with persistent shoulder instability from engagement of the Hill-Sachs on the anterior glenoid. In these cases, the combination of a Hill-Sachs remplissage and the Latarjet procedure can be effective in preventing persistent instability. In this technical note, the surgical technique of an arthroscopic Hill-Sachs remplissage in combination with an open Latarjet procedure is presented.
前盂肱关节不稳患者的双极骨丢失治疗具有挑战性。治疗目标是通过确保肱骨头保持在关节盂窝内来恢复稳定性。这可以通过关节镜下Bankart手术和充填术联合进行（关节盂骨丢失<25%），或者通过Latarjet手术（关节盂骨丢失>25%）来实现。在关节盂和肱骨头均存在更严重双极骨丢失的病例中，传统方法是延长关节盂的关节弧并忽略Hill-Sachs损伤。然而，最近研究表明，这仍可能导致“偏离轨迹”的情况，即Hill-Sachs损伤与前关节盂接触导致持续性肩关节不稳。在这些病例中，Hill-Sachs充填术和Latarjet手术联合使用可有效预防持续性不稳。在本技术说明中，介绍了关节镜下Hill-Sachs充填术与开放Latarjet手术联合的手术技术。
