肩后向不稳定中的临界肩盂骨丢失。
Critical Glenoid Bone Loss in Posterior Shoulder Instability.
机构信息
Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA.
出版信息
Am J Sports Med. 2018 Apr;46(5):1058-1063. doi: 10.1177/0363546518758015. Epub 2018 Mar 14.
BACKGROUND
There is currently no consensus regarding the amount of posterior glenoid bone loss that is considered critical. Critical bone loss is defined as the amount of bone loss that occurs in which an isolated labral repair will not sufficiently restore stability.
PURPOSE
The purpose is to identify the critical size of the posterior defect.
STUDY DESIGN
Controlled laboratory study.
METHODS
Eleven cadaveric shoulders were tested. With the use of a custom robot device, a 50-N compressive force was applied to the glenohumeral joint, and the peak force that was required to translate the humeral head posteriorly and the lateral displacement that occurred with translation were measured. The defect size was measured as a percentage of the glenoid width. Testing was performed in 11 conditions: (1) intact glenoid and labrum, (2) simulated reverse Bankart lesion, (3) the reverse Bankart lesion repaired, (4) a 10% defect, (5) the reverse Bankart lesion repaired, (6) a 20% defect, (7) the reverse Bankart lesion repaired, (8) a 30% defect, (9) the reverse Bankart lesion repaired, (10) a 40% defect, and (11) the reverse Bankart repaired.
RESULTS
Force and displacement decreased as the size of the osseous defect increased. The mean peak force that occurred with posterior displacement in specimens with a glenoid defect ≥20% and a reverse Bankart repair (13 ± 9 N) was significantly lower than the peak force that occurred in specimens with an isolated reverse Bankart repair (22 ± 10 N) ( P = .0451). In addition, the mean lateral displacement was significantly less in the specimens with a 20% glenoid defect and a reverse Bankart repair (0.61 ± 0.57 mm) compared with the lateral displacement that occurred in specimens with an isolated reverse Bankart repair (1.6 ± 0.78 mm) ( P = .0058).
CONCLUSION
An osseous defect that is ≥20% of the posterior glenoid width remains unstable after isolated reverse Bankart repair.
CLINICAL RELEVANCE
A bony restoration procedure of the glenoid may be necessary in shoulders with a posterior glenoid defect that is ≥20% of the glenoid width.
背景
目前对于何种程度的肩胛盂后骨量丢失被认为是“临界”仍未达成共识。临界骨量丢失是指发生骨量丢失的程度，在这种程度下，单纯的盂唇修复不足以恢复稳定性。
目的
旨在确定肩胛盂后缘缺损的临界大小。
研究设计
对照实验室研究。
方法
对 11 具尸体肩关节进行了测试。使用定制的机器人设备，向盂肱关节施加 50N 的压缩力，测量使肱骨头向后平移所需的峰值力以及平移时发生的横向位移。将缺损大小测量为肩胛盂宽度的百分比。在 11 种情况下进行测试：（1）完整的肩胛盂和盂唇，（2）模拟反向 Bankart 损伤，（3）修复后的反向 Bankart 损伤，（4）10%的缺损，（5）修复后的反向 Bankart 损伤，（6）20%的缺损，（7）修复后的反向 Bankart 损伤，（8）30%的缺损，（9）修复后的反向 Bankart 损伤，（10）40%的缺损，以及（11）修复后的反向 Bankart 损伤。
结果
随着骨缺损大小的增加，力和位移减小。在肩胛盂缺损≥20%且存在反向 Bankart 修复的标本中，发生后向位移的平均峰值力（13±9N）显著低于单独存在反向 Bankart 修复的标本中的峰值力（22±10N）（P=0.0451）。此外，在肩胛盂缺损为 20%且存在反向 Bankart 修复的标本中，平均横向位移（0.61±0.57mm）显著小于单独存在反向 Bankart 修复的标本中的横向位移（1.6±0.78mm）（P=0.0058）。
结论
单独进行反向 Bankart 修复后，≥20%的肩胛盂后缘骨缺损仍不稳定。
临床相关性
对于肩胛盂后缘缺损≥20%的肩关节，可能需要进行肩胛盂骨修复手术。
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