Suppr超能文献

肩关节不稳手术失败的评估与处理

Evaluation and Management of Failed Shoulder Instability Surgery.

作者信息

Cartucho António, Moura Nuno, Sarmento Marco

机构信息

Orthopaedic Department Cuf Descobertas Hospital Rua Mário Botas 1998-018 Lisbon - Portugal.

出版信息

Open Orthop J. 2017 Aug 31;11:897-908. doi: 10.2174/1874325001711010897. eCollection 2017.

Abstract

BACKGROUND

Failed shoulder instability surgery is mostly considered to be the recurrence of shoulder dislocation but subluxation, painful or non-reliable shoulder are also reasons for patient dissatisfaction and should be considered in the notion.

METHODS

The authors performed a revision of the literature and online contents on evaluation and management of failed shoulder instability surgery.

RESULTS

When we look at the reasons for failure of shoulder instability surgery we point the finger at poor patient selection, technical error and an additional traumatic event. More than 80% of surgical failures, for shoulder instability, are associated with bone loss. Quantification of glenoid bone loss and investigation of an engaging Hill-Sachs lesion are determining facts. Adequate imaging studies are determinant to assess labrum and capsular lesions and to rule out associated pathology as rotator cuff tears. CT-scan is the method of choice to diagnose and quantify bone loss. Arthroscopic soft tissue procedures are indicated in patients with minimal bone loss and no contact sports. Open soft tissue procedures should be performed in patients with small bone defects, with hiperlaxity and practicing contact sports. Soft tissue techniques, as postero-inferior capsular plication and remplissage, may be used in patients with less than 25% of glenoid bone loss and Hill-Sachs lesions. Bone block procedures should be used for glenoid larger bone defects in the presence of an engaging Hill-Sachs lesion or in the presence of poor soft tissue quality. A tricortical iliac crest graft may be used as a primary procedure or as a salvage procedure after failure of a Bristow or a Latarjet procedure. Less frequently, the surgeon has to address the Hill-Sachs lesion. When a 30% loss of humeral head circumference is present a filling graft should be used.

CONCLUSION

Reasons for failure are multifactorial. In order to address this entity, surgeons must correctly identify the causes and tailor the right solution.

摘要

背景

肩关节不稳定手术失败大多被认为是肩关节脱位复发,但半脱位、疼痛或不可靠的肩部也是患者不满意的原因,在这一概念中应予以考虑。

方法

作者对关于肩关节不稳定手术失败的评估和处理的文献及在线内容进行了综述。

结果

当我们审视肩关节不稳定手术失败的原因时,我们将矛头指向患者选择不当、技术失误和额外的创伤事件。超过80%的肩关节不稳定手术失败与骨质流失有关。肩胛盂骨质流失的量化以及对嵌顿性希尔-萨克斯损伤的研究是决定性因素。充分的影像学检查对于评估盂唇和关节囊损伤以及排除如肩袖撕裂等相关病变至关重要。CT扫描是诊断和量化骨质流失的首选方法。对于骨质流失极少且不进行接触性运动的患者,可采用关节镜下软组织手术。对于有小骨缺损、关节过度松弛且进行接触性运动的患者,应进行开放性软组织手术。对于肩胛盂骨质流失少于25%且存在希尔-萨克斯损伤的患者,可采用后下关节囊折叠和充填等软组织技术。对于存在嵌顿性希尔-萨克斯损伤或软组织质量差的较大肩胛盂骨缺损,应采用骨块手术。三皮质髂嵴移植可作为初次手术或在布里斯托或拉塔热手术失败后的挽救手术。较少情况下,外科医生必须处理希尔-萨克斯损伤。当肱骨头周长损失30%时,应使用填充移植。

结论

失败原因是多因素的。为了解决这一问题,外科医生必须正确识别病因并制定合适的解决方案。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e253/5611793/fa56c0ecb46a/TOORTHJ-11-897_F1.jpg

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验