Zhang Hongxin, Gong Jicheng, Xie Meiming, Tang Kanglai
Department of Orthopaedic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, People's Republic of China.
J Orthop Surg Res. 2017 Dec 15;12(1):193. doi: 10.1186/s13018-017-0687-8.
The present study investigated individualized coracoid osteotomy for 3D congruent arc glenoid reconstruction and evaluated the clinical outcomes in recurrent anterior shoulder dislocation.
From January 2005 to July 2015, 78 patients with glenoid defect underwent coracoid and conjoint tendon transposition. The patients were divided into the individualized group (n = 34) and the non-individualized group (n = 44). All patients had CT data to reconstruct the shoulder model using Mimics software. In the individualized group, the individual coracoid osteotomy and bone fixation position parameters were measured from preoperative planification through simulating a 3D congruent arc glenoid reconstruction model. The non-individualized group underwent classic Bristow-Latarjet (B-L) procedure. The postoperative evaluation parameters included 3D congruent arc index, coracoid bone position, shoulder osteoarthritis index (Samilson-Prieto) and shoulder function score (Rowe, Constant-Murley score).
The mean follow-up time was 51.0 months (ranging from 24 to 146). The individualized group got 3D congruent arc reconstruction of the glenoid by postoperative CT scanning. Bone position was more precise in the individual group than that in the B-L group. There was a lower incidence of shoulder osteoarthritis (Samilson-Prieto) in the individual group compared with that in the B-L group: 0 vs 13.6% (mild 6/44, P = 0.027), respectively. No significant difference was observed between the individual and B-L groups in rate of re-dislocation: 0 vs 4.5% (2/44, P = 0.315), respectively. The postoperative Rowe and Constant score was significantly improved but was not significantly different between the two groups.
The individual procedure achieved 3D congruent arc glenoid reconstruction. The clinical effects in patients with medium glenoid defect were good, especially the low incidence of shoulder osteoarthritis in middle-term follow-up.
本研究探讨个体化喙突截骨术用于三维全等弧肩胛盂重建，并评估复发性前肩关节脱位的临床疗效。
2005年1月至2015年7月，78例肩胛盂缺损患者接受了喙突及联合肌腱转位术。患者被分为个体化组（n = 34）和非个体化组（n = 44）。所有患者均有CT数据，使用Mimics软件重建肩部模型。在个体化组中，通过模拟三维全等弧肩胛盂重建模型，从术前规划中测量个体化喙突截骨和骨固定位置参数。非个体化组采用经典的布里斯托-拉塔热（B-L）手术。术后评估参数包括三维全等弧指数、喙突骨位置、肩关节骨关节炎指数（萨米尔森-普列托）和肩关节功能评分（罗伊、康斯坦特-默里评分）。
平均随访时间为51.0个月（24至146个月）。个体化组术后CT扫描显示肩胛盂实现了三维全等弧重建。个体化组的骨位置比B-L组更精确。个体化组肩关节骨关节炎（萨米尔森-普列托）的发生率低于B-L组：分别为0%和13.6%（轻度6/44，P = 0.027）。个体化组和B-L组在再脱位率方面无显著差异：分别为0%和4.5%（2/44，P = 0.315）。术后罗伊和康斯坦特评分均显著提高，但两组间无显著差异。
个体化手术实现了肩胛盂的三维全等弧重建。中度肩胛盂缺损患者的临床效果良好，尤其是中期随访中肩关节骨关节炎的发生率较低。
