Department of Rheumatology and Arthroscopy, Marienkrankenhaus Düsseldorf-Kaiserswerth, An St Swidbert 17, Düsseldorf, Germany.
Department of Diagnostic Radiology, St. Vinzenz Hospital, Schloßstraße 85, Düsseldorf, Germany.
Knee Surg Sports Traumatol Arthrosc. 2018 Jan;26(1):299-305. doi: 10.1007/s00167-017-4757-6. Epub 2017 Oct 23.
Recurrent anterior instability of the glenohumeral joint is a demanding condition, especially in cases of glenoid bone loss. Various treatment options have been described, such as arthroscopic grafting techniques and the Latarjet procedure. In this study, the degree to which an arthroscopically applied iliac crest graft restores the glenoid anatomy was evalutated.
Nine patients (three women and six men) with an average age of 31 ± 9 years (21-46 years) who were treated with an arthroscopic iliac crest graft technique were included in this study. After a mean follow up of 34 ± 10 months (19-50 months) after the procedure, MRI scans of both shoulders were performed and the glenoid width, Glenoid Index (GI), Pixel Signal intensity (PSI), thickness of the tissue covering the articular aspect of the graft, inclination, version, concavity and balance stability angle were measured.
All scans showed the cultivation of tissue on the graft, which visually resembled the cartilage of the native ipsilateral glenoid. Additionally, reshaping of the graft to repair the glenoid configuration could be observed. Glenoid width (p = 0.022) and GI (p < 0.001) increased significantly through surgery. The tissue examined on the graft showed a significant pixel intensity gap (p = 0.017) but comparable thickness (n.s.) in relation to native cartilage. The remaining parameters did not differ significantly between both shoulders.
In the cohort presented, iliac crest grafts were able to restore the glenoid configuration, and the glenoid was re-shaped to its native contour. Additionally, cartilage-like scar tissue with similar thickness as healthy cartilage was formed on the articular side of the graft. These results suggest that glenoid reconstruction is not only important for prevention of recurrence, but also for restoration of the native glenoid anatomy.
Level III-retrospective cohort study.
复发性盂肱关节前不稳定是一种具有挑战性的疾病，尤其是在存在肩胛盂骨丢失的情况下。已经描述了各种治疗选择，例如关节镜下移植物技术和 Latarjet 手术。在这项研究中，评估了关节镜下应用髂嵴移植物修复肩胛盂解剖结构的程度。
本研究纳入了 9 例（3 名女性和 6 名男性）平均年龄为 31±9 岁（21-46 岁）的患者，他们接受了关节镜下髂嵴移植物技术治疗。在手术后平均 34±10 个月（19-50 个月）的随访后，对双侧肩部进行 MRI 扫描，并测量了肩胛盂宽度、Glenoid Index（GI）、像素信号强度（PSI）、覆盖移植物关节面的组织厚度、倾斜度、版本、凹陷度和平衡稳定角。
所有扫描均显示移植物上有组织培养，其外观类似于同侧天然肩胛盂的软骨。此外，还可以观察到移植物的重塑以修复肩胛盂的形态。手术治疗后，肩胛盂宽度（p=0.022）和 GI（p<0.001）显著增加。移植物上的组织显示出显著的像素强度间隙（p=0.017），但与天然软骨相比，厚度相当（无统计学差异）。其余参数在双侧肩部之间无显著差异。
在本研究中，髂嵴移植物能够恢复肩胛盂的形态，并且肩胛盂被重塑为其天然轮廓。此外，在移植物的关节面形成了类似软骨的瘢痕组织，其厚度与健康软骨相似。这些结果表明，肩胛盂重建不仅对预防复发很重要，而且对恢复天然肩胛盂解剖结构也很重要。
III 级-回顾性队列研究。
