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关节镜辅助下的拉塔热手术:一种提高移植物和螺钉置入准确性的简便且可重复的技术。

Arthroscopically-assisted Latarjet: an easy and reproducible technique for improving the accuracy of graft and screw placement.

作者信息

Taverna Ettore, Guarrella Vincenzo, Cartolari Roberto, Ufenast Henri, Broffoni Laura, Barea Christophe, Garavaglia Guido

机构信息

IRRCS Istituto Ortopedico Galeazzi, Milan, Italy.

OSG - Bellinzona, Bellinzona, Switzerland.

出版信息

Shoulder Elbow. 2018 Apr;10(2):99-106. doi: 10.1177/1758573217706701. Epub 2017 May 15.

Abstract

BACKGROUND

The effectiveness of the Latarjet largely depends on accurate graft placement, as well as on proper position and direction of the screws. We present our technique for an arthroscopically-assisted Latarjet comparing radiological results with the open technique.

METHODS

We retrospectively reviewed the postoperative computed tomography scans of 38 patients who underwent a Latarjet procedure. For 16 patients, the procedure was performed with the open technique and, for 22 patients, it was performed using an arthroscopically-assisted technique. An independent radiologist evaluated graft and hardware position, as well as graft integration or resorption. Postoperative complications were also documented.

RESULTS

The graft was correctly placed in only 18.8% of cases in the open group and 72.7% of cases in the arthroscopically-assisted group. There were no postoperative complications in the arthroscopically-assisted group, whereas one patient had a recurrence and two required hardware removal in the open group.

CONCLUSIONS

The Latarjet procedure is a challenging procedure for which a key point is the correct placement of the coracoid graft onto the glenoid neck and correct position of the screws. The present study substantiates a clear benefit for the use of a guide with an arthroscopically-assisted technique in terms of graft and hardware placement. At short-term follow-up, there appears to be a benefit for graft integration and avoidance of resorption.

摘要

背景

Latarjet手术的有效性很大程度上取决于移植物的精确放置以及螺钉的正确位置和方向。我们展示了关节镜辅助下Latarjet手术的技术,并将放射学结果与开放手术技术进行比较。

方法

我们回顾性分析了38例行Latarjet手术患者的术后计算机断层扫描。16例患者采用开放手术技术,22例患者采用关节镜辅助技术。由一名独立放射科医生评估移植物和硬件的位置,以及移植物的整合或吸收情况。同时记录术后并发症。

结果

开放组仅18.8%的病例移植物放置正确,关节镜辅助组为72.7%。关节镜辅助组无术后并发症,而开放组有1例复发,2例需要取出硬件。

结论

Latarjet手术是一项具有挑战性的手术,关键在于将喙突移植物正确放置在肩胛盂颈部并使螺钉位置正确。本研究证实了在移植物和硬件放置方面,关节镜辅助技术使用导向器具有明显优势。在短期随访中,似乎有利于移植物整合并避免吸收。

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本文引用的文献

2
Accuracy of Latarjet graft and screw position after using novel drill guide.
Eur J Trauma Emerg Surg. 2017 Oct;43(5):645-649. doi: 10.1007/s00068-016-0703-4. Epub 2016 Jul 4.
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Accurate coracoid graft placement through use of a drill guide for the Latarjet procedure.
J Shoulder Elbow Surg. 2013 May;22(5):701-8. doi: 10.1016/j.jse.2012.06.012. Epub 2012 Sep 21.
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