Bockmann Benjamin, Venjakob Arne Johannes, Reichwein Frank, Hagenacker Marthe, Nebelung Wolfgang
Department of Rheumatology and Arthroscopy, Marienkrankenhaus Düsseldorf-Kaiserswerth, An St Swidbert 17, Düsseldorf, Germany.
Arch Orthop Trauma Surg. 2018 Nov;138(11):1557-1562. doi: 10.1007/s00402-018-2964-3. Epub 2018 Jun 11.
Glenoid bone loss in recurrent anterior instability of the shoulder needs to be addressed to restore joint stability. Over the last years, several arthroscopic methods have been described to treat this condition. However, no clinical mid-term results have been presented for arthroscopic iliac crest bone grafting procedures.
We included 32 patients with significant glenoid bone loss and repetitive dislocations of the shoulder who were treated in our shoulder unit with a previously described all-arthroscopic reconstruction technique. All patients filled out a questionnaire evaluating repetitive dislocations, consumption of pain medicine, Constant Score (CS, adapted to age and gender), activities of daily living (ADL), visual analogue scale for pain (VAS) as well as the Western Ontario Shoulder Instability Index (WOSI). Additionally, all complications were recorded.
After a mean follow-up of 42 months, three traumatic dislocations had been observed. With an ADL of 25 points (95% CI 24-27), a WOSI of 71% (95% CI 65-76) and CS of 87 points (95% CI 82-92), our patients showed good functional results. The VAS result for pain was 2.1 (95% CI 1.5-2.6). No patient reported the regular usage of pain medicine related to the shoulder instability at final follow-up.
The all-arthroscopic glenoid reconstruction using iliac crest grafts shows good functional results with a recurrence rate of 9%. At final follow-up 42 months after surgery, our patients showed low pain levels and acceptable complications.
复发性肩关节前脱位中的肩胛盂骨缺损需要得到处理以恢复关节稳定性。在过去几年中，已经描述了几种关节镜下治疗这种情况的方法。然而，尚未有关于关节镜下髂嵴骨移植手术的中期临床结果报道。
我们纳入了32例肩胛盂骨缺损明显且肩关节反复脱位的患者，这些患者在我们的肩关节治疗单元接受了先前描述的全关节镜重建技术治疗。所有患者均填写了一份问卷，评估反复脱位情况、止痛药使用情况、Constant评分（CS，根据年龄和性别进行调整）、日常生活活动能力（ADL）、疼痛视觉模拟量表（VAS）以及西安大略肩关节不稳定指数（WOSI）。此外，记录了所有并发症。
平均随访42个月后，观察到3例创伤性脱位。我们的患者ADL评分为25分（95%可信区间24 - 27），WOSI为71%（95%可信区间65 - 76），CS为87分（95%可信区间82 - 92），显示出良好的功能结果。疼痛的VAS结果为2.1（95%可信区间1.5 - 2.6）。在末次随访时，没有患者报告因肩关节不稳定而常规使用止痛药。
使用髂嵴移植的全关节镜肩胛盂重建显示出良好的功能结果，复发率为9%。在术后42个月的末次随访时，我们的患者疼痛程度较低，并发症可接受。
