Department of Radiology, NYU Langone Medical Center, New York, NY, USA.
Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
J Shoulder Elbow Surg. 2018 Aug;27(8):1475-1482. doi: 10.1016/j.jse.2018.01.008. Epub 2018 Feb 21.
The goal of the Latarjet procedure is restoration of shoulder stability enabled by accurate graft positioning and union. This study aimed to establish a reproducible method of quantitatively assessing coracoid graft osseous union percentage (OUP) using computed tomography (CT) scans and to determine the effect of other factors on the OUP.
Postoperative CT scans of 41 consecutive patients treated with the open Latarjet procedure (37% primary, 63% revision) for anterior glenohumeral instability were analyzed for the OUP, position of the graft, and screw type and angle. Two musculoskeletal radiologists independently examined the images 2 times, and intraobserver and interobserver reliability was calculated using intraclass correlation coefficient (ICC).
Mean OUP was 66% (range, 0%-94%) using quantitate methods, with good intraobserver reliability (ICC = 0.795) and interobserver reliability (ICC = 0.797). Nonunion and significant graft resorption was found in 2 patients. No significant difference was found in the mean OUP in the primary (63%) vs. revision Latarjet procedure (67%). Grafts were flush in 39%, medial in 36%, and lateral in 8%. The medial and neutral graft position was associated with slightly higher OUP (72% and 69%) compared with lateral (65%). OUP was higher when the superior screw angle was less than 17° and the inferior screw angle was less than 24°. This difference did not reach statistical significance. Screw type was not associated with significant difference in OUP.
Quantitative assessment of osseous union of the graft using a reproducible method that we introduced showed similar OUP in the primary and revision Latarjet procedure.
Latarjet 手术的目的是通过准确的移植物定位和愈合来恢复肩关节稳定性。本研究旨在建立一种使用计算机断层扫描（CT）定量评估喙突移植物骨性愈合百分比（OUP）的可重复方法，并确定其他因素对 OUP 的影响。
对 41 例接受开放式 Latarjet 手术（37%为原发性，63%为复发性）治疗的前肩盂肱关节不稳定患者的术后 CT 扫描进行分析，以评估 OUP、移植物位置、螺钉类型和角度。两位骨骼肌肉放射科医生独立检查图像 2 次，并使用组内相关系数（ICC）计算观察者内和观察者间的可靠性。
使用定量方法，OUP 的平均值为 66%（范围 0%-94%），观察者内可靠性（ICC=0.795）和观察者间可靠性（ICC=0.797）良好。2 例患者发现有不愈合和明显的移植物吸收。原发性（63%）和复发性 Latarjet 手术（67%）的平均 OUP 无显著差异。移植物平齐 39%，内移 36%，外移 8%。内侧和中性移植物位置与外侧（65%）相比，OUP 略高（72%和 69%）。当上螺钉角度小于 17°且下螺钉角度小于 24°时，OUP 更高。但这种差异没有达到统计学意义。螺钉类型与 OUP 无显著相关性。
我们介绍的一种可重复的方法，用于定量评估移植物骨性愈合，显示原发性和复发性 Latarjet 手术的 OUP 相似。
