IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
Servizio di Chirurgia dell'Arto Superiore, OBV, Mendrisio, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2018 Dec;26(12):3780-3787. doi: 10.1007/s00167-018-4921-7. Epub 2018 Apr 6.
A group of patients affected by bone loss in the context of recurrent anterior shoulder instability were treated arthroscopically with a modified Eden-Hybinette technique since 2005. The last modification was made in 2013, consisting of fixation using a pair of specifically designed double round Endobuttons, which secure the bone graft to the glenoid rim placed through a guide. This report describes patients operated on after this last modification. No reports have described the results of this technique, and the purpose of this study was to assess early clinical and radiological results of an arthroscopic bone block procedure with double round Endobutton fixation. We hypothesized that this technique would restore shoulder stability in patients with anteroinferior glenohumeral instability with glenoid bone deficit, with excellent clinical and radiological results.
The clinical and radiological efficacy of this procedure was retrospectively evaluated in 26 patients with an average follow-up of 29.6 months (range 24-33 months).
At minimum 2-year follow-up, we had no recurrent anterior dislocations, excellent clinical results [average Walch-Duplay score 93.2, (SD 7.8); average Rowe score, 96.4 (SD 6.5); average SSV, 87.4 (SD 12.1); satisfaction rate, 88.5%; average loss of external rotation, 4.4° (SD 8.7°)] optimal graft positioning, and a healing rate of 92.3% on computed tomography scan.
Arthroscopic bone block grafting combined with a standard Bankart repair restored shoulder stability in patients with anteroinferior glenohumeral instability with glenoid bone deficit, with excellent clinical and radiological results. This procedure did not substantially limit external rotation, allowing a high rate of return to sports even among competitive, overhead, and "at risk" athletes.
自 2005 年以来，我们采用改良的 Eden-Hybinette 技术对一组因复发性肩关节前不稳定而导致骨丢失的患者进行关节镜治疗。最后一次修改是在 2013 年进行的，包括使用一对专门设计的双圆形 Endobutton 进行固定，该固定将骨移植物固定到通过导向器放置在肩胛盂边缘的骨块上。本报告描述了在此最后一次修改后进行手术的患者。尚无报道描述该技术的结果，本研究的目的是评估关节镜下骨块加双圆形 Endobutton 固定术的早期临床和影像学结果。我们假设该技术将恢复有肩胛盂骨缺损的前下盂肱不稳定患者的肩关节稳定性，并取得出色的临床和影像学结果。
回顾性评估了 26 例患者的临床和影像学疗效，平均随访 29.6 个月（范围 24-33 个月）。
至少 2 年的随访期内，我们没有出现复发性前脱位，临床结果优异[平均 Walch-Duplay 评分 93.2（标准差 7.8）；平均 Rowe 评分 96.4（标准差 6.5）；平均 SSV 评分 87.4（标准差 12.1）；满意度 88.5%；平均外旋丧失 4.4°（标准差 8.7°）]，移植物位置理想，CT 扫描显示愈合率为 92.3%。
关节镜下骨块移植结合标准 Bankart 修复术恢复了有肩胛盂骨缺损的前下盂肱不稳定患者的肩关节稳定性，取得了出色的临床和影像学结果。该手术并未明显限制外旋，即使是竞技性、过顶性和“高危”运动员，也能使患者有很高的几率重返运动。
