Joshi Deepak, Gupta Lalit Mohan, Tanwar Milind, Lal Ajay, Chaudhary Deepak
Sports Injury Centre, Safdarjung Hospital and VMMC, New Delhi, India.
Orthop J Sports Med. 2018 Mar 22;6(3):2325967118761635. doi: 10.1177/2325967118761635. eCollection 2018 Mar.
Recurrent shoulder dislocation and anterior instability are most commonly attributed to pathology of the capsulolabral complex with the presence of bony loss at the humeral and glenoid surfaces. Unassessed bone loss has been a cause of failure of primary soft tissue procedures or recurrence of symptoms, despite adequate address of soft tissue pathology.
To study the anthropometric and radiologic dimensions of the coracoid in relation to glenoid bone loss, its adequacy in filling glenoid defects in an Indian population, and whether the choice of surgical technique (congruent arc vs classical) and graft positioning alters the surgical results. This study also intended to establish whether computed tomography measurements correlate with actual anthropometric measurements.
Cross-sectional study; Level of evidence, 3.
A total of 64 participants with 108 healthy shoulders were included in this study. Additionally, 100 skeletally mature bone specimens of the scapula were measured to assess glenoid diameter as well as coracoid width and length in 2 perpendicular planes with a humeral subtraction 3-dimensional en face glenoid view.
Specimen and participant measurements proved that the congruent arc technique was able to fill up to 50% more glenoid bone loss than the classical technique in an Indian population (mean ± SD, 13.45 ± 6.97 vs 7.96 ± 4.89 mm, respectively), with computed tomography being the best and most accurate modality to study it. The mean difference in the bone block length restoration of the glenoid bony arc was 5.41 ± 2.08 mm. Radii of curvature were congruent in populations of the Indian subcontinent.
The congruent arc technique can be performed in an Indian population but with caution and careful presurgical assessment of bone loss. However, adequate coracoid dimension to accommodate the implant for fixation without failure must be ensured, as anthropometry suggests the existence of a subset of the population in whom the graft may have compromised width for accommodating standard implants for fixation.
复发性肩关节脱位和前方不稳定最常见的原因是关节囊盂唇复合体病变，同时伴有肱骨头和肩胛盂表面的骨质缺损。尽管软组织病变已得到充分处理，但未评估的骨质缺损一直是初次软组织手术失败或症状复发的原因。
研究喙突的人体测量学和影像学尺寸与肩胛盂骨质缺损的关系，其在印度人群中填充肩胛盂缺损的充分性，以及手术技术（全等弧技术与经典技术）的选择和移植物定位是否会改变手术结果。本研究还旨在确定计算机断层扫描测量值与实际人体测量值是否相关。
横断面研究；证据等级，3级。
本研究共纳入64名参与者的108个健康肩部。此外，测量了100个肩胛骨骼成熟的骨标本，以在肱骨减影三维正面肩胛盂视图下的2个垂直平面评估肩胛盂直径以及喙突宽度和长度。
标本和参与者测量结果证明，在印度人群中，全等弧技术比经典技术能够多填充高达50%的肩胛盂骨质缺损（分别为平均±标准差，13.45±6.97 mm和7.96±4.89 mm），计算机断层扫描是研究它的最佳且最准确的方式。肩胛盂骨弧的骨块长度恢复的平均差异为5.41±2.08 mm。印度次大陆人群的曲率半径一致。
全等弧技术可在印度人群中进行，但需谨慎并在术前仔细评估骨质缺损情况。然而，必须确保有足够的喙突尺寸来容纳植入物进行固定而不失败，因为人体测量学表明存在一部分人群，其移植物可能宽度不足，无法容纳标准的固定植入物。
