Provencher Matthew T, Sanchez George, Schantz Katrina, Ferrari Marcio, Sanchez Anthony, Frangiamore Salvatore, Mannava Sandeep
Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
The Steadman Clinic, Vail, Colorado, U.S.A.
Arthrosc Tech. 2017 Feb 27;6(1):e255-e261. doi: 10.1016/j.eats.2016.10.017. eCollection 2017 Feb.
The treatment of recurrent glenohumeral instability, especially with a concomitant bony lesion, remains challenging. This is especially true in the case of posterior instability given its less common incidence. Moreover, the presence of an engaging reverse Hill-Sachs lesion in combination with posterior instability will result in the need for a more aggressive treatment option. In comparison with a Hill-Sachs lesion, a reverse Hill-Sachs lesion features greater chondral deficiency that must be addressed during treatment. We propose the talus allograft as a potential allograft for treatment of an engaging reverse Hill-Sachs lesion. The superior articular surface of the talus may be used to reconstruct the articular surface of the humeral head. In this technical note, we describe our preferred primary technique for treatment of an engaging reverse Hill-Sachs lesion with recurrent glenohumeral instability through use of a fresh osteochondral talus allograft, as well as discuss the advantages and disadvantages of this allograft option.
复发性肩肱关节不稳的治疗，尤其是伴有骨病变时，仍然具有挑战性。对于后向不稳而言，因其发病率较低，情况更是如此。此外，伴有后向不稳的嵌顿性反Hill-Sachs损伤的存在将导致需要更积极的治疗方案。与Hill-Sachs损伤相比，反Hill-Sachs损伤的软骨缺损更大，治疗期间必须予以处理。我们提出距骨同种异体移植物作为治疗嵌顿性反Hill-Sachs损伤的一种潜在同种异体移植物。距骨的上关节面可用于重建肱骨头的关节面。在本技术说明中，我们描述了通过使用新鲜的带骨软骨的距骨同种异体移植物治疗伴有复发性肩肱关节不稳的嵌顿性反Hill-Sachs损伤的首选主要技术，并讨论了这种同种异体移植物选择的优缺点。
