Valenti Philippe, Maroun Charbel, Wagner Eric, Werthel Jean-David
Paris Shoulder Unit, Clinique Bizet, Paris, France.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
Arthrosc Tech. 2018 Mar 5;7(4):e313-e320. doi: 10.1016/j.eats.2017.09.009. eCollection 2018 Apr.
The arthroscopic Latarjet procedure is challenging because it can be difficult to place 2 screws parallel to the glenoid surface and a medial portal (dangerous for the brachial plexus) is mandatory. In addition, precise positioning of the coracoid bone block flush with the joint line and in a subequatorial position as recommended is troublesome without the use of a guiding system because of the arthroscopic lens distortion. To improve the reproducibility of the arthroscopic Latarjet procedure and to minimize the risk of nerve complications, we developed a guiding system to optimize the positioning of the coracoid bone block and 2 cortical buttons to facilitate its fixation. Four portals are used: a posterior standard portal and 3 anterior portals, all lateral to the conjoint tendon. The anterior rim of the glenoid and the coracoid process are prepared. Two holes are drilled in the glenoid and in the coracoid process with 2 specific guides. The subscapularis is then split, and 2 cortical buttons are passed from posterior to anterior through the tunnels with a shuttle relay. The coracoid process undergoes osteotomy and is guided through the split in the subscapularis to the anteroinferior rim of the glenoid by pulling on the cortical buttons.
关节镜下Latarjet手术具有挑战性，因为很难将两枚螺钉平行于关节盂表面置入，而且内侧入路（对臂丛神经有危险）是必不可少的。此外，由于关节镜镜头的畸变，如果不使用引导系统，按照推荐将喙突骨块精确地与关节线平齐并置于赤道下位置会很麻烦。为了提高关节镜下Latarjet手术的可重复性并将神经并发症的风险降至最低，我们开发了一种引导系统，以优化喙突骨块和两个皮质纽扣的定位，便于其固定。使用四个入路：一个后方标准入路和三个前方入路，均位于联合肌腱外侧。准备关节盂前缘和喙突。用两个特定的导向器在关节盂和喙突上钻孔。然后劈开肩胛下肌，通过穿梭装置将两个皮质纽扣从后向前穿过隧道。对喙突进行截骨，并通过牵拉皮质纽扣将其引导通过肩胛下肌的劈开处至关节盂的前下缘。
