Sportsmed, Mumbai, India; Department of Orthopaedic Surgery, Seth GS Medical College, King Edward VII Memorial Hospital, Mumbai, India.
Sportsmed, Mumbai, India; Department of Orthopaedic Surgery, Seth GS Medical College, King Edward VII Memorial Hospital, Mumbai, India.
J Shoulder Elbow Surg. 2019 Dec;28(12):2418-2426. doi: 10.1016/j.jse.2019.04.050. Epub 2019 Jul 16.
This study analyzed the alteration in glenoid articular geometry with increasing anterior bone loss, as well as its subsequent correction with 2 modifications of the Latarjet procedure.
Anterior defects were simulated by creating glenoid osteotomies (10%, 20%, 30%, and 40%), and defects were reconstructed using 2 Latarjet modifications (classic and congruent arc). A total of 108 computed tomography scans were performed (1) on intact scapulae (n = 12), (2) after each bone defect (n = 48), and (3) after each reconstruction (n = 48). Glenoid parameters (width, area, arc length, and version) were analyzed on computed tomography scans. Statistical analysis was used to determine significant differences between intact, deficient, and reconstructed glenoids.
All parameters were reduced with every 10% defect increment (mean change in width, 2.5 mm; area, 64 mm; version, 2.2°; and arc length, 2.2 mm). Width correction with the classic Latarjet procedure was not statistically significant in 30% and 40% defects. Area correction in 30% defects was not significant with the classic Latarjet procedure and was significantly undercorrected in 40% defects. Version correction was not significant after the classic Latarjet procedure in 20%, 30%, and 40% defects. Arc-length correction was not significant in 20% and 30% defects with the classic Latarjet procedure and was significantly undercorrected in 40% defects. The congruent-arc Latarjet procedure overcorrected glenoid parameters in all defects; however, area and arc length were not significantly different from intact glenoids in 40% defects (P < .05).
Glenoid articular geometry is progressively altered with a sequential increase in anterior bone defects from 0% to 40%. The classic Latarjet procedure provided significant correction in bone defects of 10% and 20%. The congruent-arc Latarjet procedure restored and overcorrected most parameters even in 40% glenoid defects.
本研究分析了随着前骨丢失的增加，肩盂关节几何形状的变化，以及通过两种 Latarjet 手术的改良来纠正这种变化。
通过创建肩胛骨关节（10%、20%、30%和 40%）来模拟前缺陷，并用两种 Latarjet 改良（经典和一致弧）来重建缺陷。总共进行了 108 次计算机断层扫描（1）在完整的肩胛骨上（n=12），（2）在每个骨缺陷后（n=48），和（3）在每个重建后（n=48）。在计算机断层扫描上分析了肩盂参数（宽度、面积、弧长和版本）。统计分析用于确定完整、缺陷和重建的肩盂之间的显著差异。
每个 10%的缺陷增加都会导致所有参数减少（宽度的平均变化，2.5 毫米；面积，64 毫米；版本，2.2°；弧长，2.2 毫米）。在 30%和 40%的缺陷中，经典 Latarjet 手术的宽度校正没有统计学意义。在 30%的缺陷中，经典 Latarjet 手术的面积校正没有统计学意义，而在 40%的缺陷中，面积校正明显不足。在 20%、30%和 40%的缺陷中，经典 Latarjet 手术后的版本校正没有统计学意义。在 20%和 30%的缺陷中，经典 Latarjet 手术的弧长校正没有统计学意义，而在 40%的缺陷中，弧长校正明显不足。一致弧 Latarjet 手术在所有缺陷中过度校正了肩盂参数；然而，在 40%的缺陷中，面积和弧长与完整的肩盂没有显著差异（P<0.05）。
随着从 0%到 40%的前骨缺损的连续增加，肩盂关节的几何形状逐渐发生变化。经典 Latarjet 手术在 10%和 20%的骨缺损中提供了显著的矫正。一致弧 Latarjet 手术即使在 40%的肩盂缺损中，也能恢复和过度矫正大多数参数。
