Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Department of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, Salzburg, Austria.
Department of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, Salzburg, Austria; Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
Arthroscopy. 2018 Feb;34(2):352-359. doi: 10.1016/j.arthro.2017.07.034.
To assess the iliac crest bone graft (ICBG) position in the en-face view and axial plane comparing arthroscopic with open procedures.
A total of 40 consecutive patients with recurrent anterior shoulder instability and glenoid bone loss over 10% treated by 2 independent orthopaedic departments were included. Two independent observers analyzed preoperative and immediate postoperative computed tomography scans of 20 open (group O) and 20 arthroscopic (group A) procedures. Defect and ICBG characteristics of the J-shaped graft in the en-face view and axial plane were manually assessed by multiplanar reconstructed computed tomography scans. Variances in terms of graft positioning were analyzed.
No significant variances in arthroscopic graft positioning were observed. The graft position in the en-face view was comparable in both groups, with the superior extent of the arthroscopic graft (40° ± 9° [inferior extent, 139° ± 16°]) lying significantly higher than the superior extent in group O (50° ± 13°, P = .005 [inferior extent, 147° ± 21°; P = .178]). The covered glenoid defect size was above 95% (98% ± 1% in group O vs 95% ± 2% in group A, P = .001). The arthroscopic graft in the axial plane showed a significantly steeper impaction angle (34.8° ± 7.8° vs 26.9° ± 9.9°, P = .010), with a significantly increased medial offset compared with group O (6.6 ± 1.7 mm vs 5.4 ± 1.3 mm, P = .024). The mediolateral step formation, however, was not significantly different (2.9 ± 1.1 mm in group A vs 3.2 ± 0.8 mm in group O, P = .289). The interobserver reliability was very good for all measurements (R = 0.969; 95% confidence interval, 0.965-0.972).
Positioning of the arthroscopic ICBG in the en-face view and axial plane is comparable to that of the open technique. Good glenoid defect coverage and glenoid concavity reconstruction can be achieved with the arthroscopic technique. The main difference compared with the open procedure is the significantly steeper impaction angle.
Level III, case-control study.
比较关节镜与开放手术，评估额状面和轴向平面中髂嵴骨移植物（ICBG）的位置。
共有 40 例由 2 个独立骨科部门治疗的复发性前肩不稳定和盂肱关节窝骨缺失超过 10%的患者纳入本研究。2 名独立观察者分析了 20 例开放（O 组）和 20 例关节镜（A 组）手术的术前和术后即刻计算机断层扫描。通过多平面重建计算机断层扫描手动评估 J 形移植物在额状面和矢状面的缺损和 ICBG 特征。分析了移植物定位的差异。
关节镜下移植物定位无显著差异。两组的移植物位置在额状面相似，关节镜下移植物的上延范围（40°±9°[下延范围，139°±16°]）明显高于 O 组的上延范围（50°±13°，P=0.005[下延范围，147°±21°；P=0.178]）。盂肱关节窝缺损的覆盖面积超过 95%（O 组为 98%±1%，A 组为 95%±2%，P=0.001）。关节镜下移植物在矢状面显示出明显更陡峭的撞击角（34.8°±7.8° vs 26.9°±9.9°，P=0.010），与 O 组相比，内侧偏移明显增加（6.6±1.7mm vs 5.4±1.3mm，P=0.024）。然而，内外侧台阶形成并无显著差异（A 组为 2.9±1.1mm，O 组为 3.2±0.8mm，P=0.289）。所有测量的观察者间可靠性均非常好（R=0.969；95%置信区间，0.965-0.972）。
关节镜 ICBG 在额状面和矢状面的定位与开放技术相当。关节镜技术可实现良好的盂肱关节窝缺损覆盖和盂肱关节窝重建。与开放手术相比，主要区别在于撞击角明显更陡峭。
III 级，病例对照研究。
