Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin, Berlin, Germany.
Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria.
J Shoulder Elbow Surg. 2018 May;27(5):824-830. doi: 10.1016/j.jse.2017.10.022. Epub 2017 Dec 28.
The coracoid transfer procedure is commonly and successfully used to treat shoulder instability in young patients. However, there is concern that the outcome of this procedure might be inferior in older patients because of decreased bone graft quality and the potential concomitant presence of irreparable rotator cuff tears (RCTs).
All patients older than 40 years treated with a coracoid transfer procedure between 1998 and 2013 because of anterior shoulder instability were included. Surgical indication criteria were anterior glenoid bone defects and/or the presence of an irreparable yet functionally compensated RCT. Of 27 consecutive patients, 25 (93%) were followed up after an average of 9 years (2-15 years) clinically as well as by means of computed tomography scans. Mean age at surgery was 62 years (40-85 years).
Nine patients (36%) were revised during the follow-up period. The average Western Ontario Shoulder Instability Index of the nonrevised patients was 556; Rowe score, 77; American Shoulder and Elbow Surgeons score, 75; Constant score, 65; and subjective shoulder value, 70%. The average preoperative instability arthropathy score of 0.7 increased to 2.0 (P < .001). An irreparable RCT showed no significant effect on the clinical outcome scores or revision rate but was associated with the development of cuff arthropathy (R = 0.89; P = .01). An increased grade of preoperative cuff arthropathy was associated with a higher revision rate (R = 0.55; P = .04).
The coracoid transfer procedure represents a joint-preserving treatment option for anterior shoulder instability in older patients with glenoid bone defects or concomitant irreparable yet functionally compensated RCTs. However, bone graft- and hardware-related complications as well as required revision operations are frequent.
喙突转移术常用于治疗年轻患者的肩关节不稳定，疗效确切。但由于移植物质量下降以及同时存在不可修复的肩袖撕裂（RCT）的可能性，人们担心该手术对老年患者的效果可能较差。
纳入 1998 年至 2013 年间因肩关节前向不稳定而行喙突转移术的所有年龄大于 40 岁的患者。手术指征为前盂肱骨缺损和/或存在不可修复但功能代偿的 RCT。27 例连续患者中，25 例（93%）在平均 9 年（2-15 年）的临床和 CT 随访中获得了随访。手术时的平均年龄为 62 岁（40-85 岁）。
9 例（36%）患者在随访期间接受了翻修。未翻修患者的平均 Western Ontario 肩关节不稳定指数为 556；Rowe 评分 77；美国肩肘外科医师协会评分 75；Constant 评分 65；主观肩关节评分 70%。术前不稳定性关节炎评分 0.7 平均增加至 2.0（P<.001）。不可修复的 RCT 对临床结果评分或翻修率无显著影响，但与肩袖关节炎的发展相关（R=0.89；P=.01）。术前肩袖关节炎程度增加与更高的翻修率相关（R=0.55；P=.04）。
对于有盂肱骨缺损或同时存在不可修复但功能代偿的 RCT 的老年患者，喙突转移术是一种保留关节的肩关节前向不稳定的治疗选择。但移植物和硬件相关并发症以及需要的翻修手术较为常见。
