Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Department of Shoulder and Elbow Surgery, Schulthess Clinic Zurich, Zurich, Switzerland.
Arch Orthop Trauma Surg. 2020 Jul;140(7):895-903. doi: 10.1007/s00402-020-03380-z. Epub 2020 Feb 24.
Donor site morbidity constitutes the most prevalent source of complications during anatomic glenoid reconstruction. Therefore, the aim of this study was to evaluate the clinical and radiologic results of arthroscopic anatomic glenoid reconstruction using an allogenic, tricortical iliac crest bone graft for glenoid bone loss in recurrent anterior shoulder instability.
Ten patients [one female/nine male, mean age 31.9 years (range, 26-40)] underwent allogenic iliac crest bone grafting and were evaluated clinically [range of motion, subscapularis tests, apprehension sign, Constant score (CS), Rowe score (RS), Walch-Duplay score (WD), Western Ontario Shoulder Instability Index (WOSI), Subjective Shoulder Value (SSV)] and radiographically [3-dimensional computed tomography (CT) scans].
After 23.2 months, the CS averaged 90 points (range, 84-98), RS 83 points (range, 50-100), WD 81 points (range, 50-100), WOSI 72% (range, 41-86) and the SSV 83% (range, 70-95). All patients showed a free range of motion and intact subscapularis muscle function. The apprehension sign was positive in three patients (30%) with a recurrent subluxation in one patient (10%). The glenoid surface area increased significantly from 84.4% (range, 73.5-92.1) preoperatively to 118.4% (range, 105.6-131.2) after surgery, while the glenoid defect was significantly reduced from 16.2% (range, 9.2-26.5) to 0.6% (range, 0-1.6). One year postoperative, total resorption of the allografts was observed with a glenoid surface area of 86.6% (range, 76.4-98.0) and corresponding increase of the glenoid defect to 14.0% (range, 2.9-23.6).
Arthroscopic glenoid reconstruction using an iliac crest bone allograft achieves satisfactory clinical results and glenohumeral stability during a short-term follow-up. However, this procedure was not observed to accomplish an anatomic reconstruction of the glenoid concavity due to excessive graft resorption.
Level IV, case series, therapeutic study.
供体部位发病率是解剖肩盂重建过程中最常见的并发症来源。因此，本研究旨在评估使用同种异体三皮质髂嵴骨移植物治疗复发性肩关节前不稳定的盂骨骨缺损的关节镜解剖肩盂重建的临床和影像学结果。
10 例患者[1 例女性/9 例男性，平均年龄 31.9 岁（范围，26-40）]接受同种异体髂嵴骨移植，并进行临床评估[活动范围、肩胛下肌试验、恐惧征、Constant 评分（CS）、Rowe 评分（RS）、Walch-Duplay 评分（WD）、Western Ontario 肩不稳定指数（WOSI）、主观肩值（SSV）]和影像学评估[三维计算机断层扫描（CT）扫描]。
术后 23.2 个月，CS 平均 90 分（范围，84-98），RS 83 分（范围，50-100），WD 81 分（范围，50-100），WOSI 72%（范围，41-86）和 SSV 83%（范围，70-95）。所有患者均表现出自由的活动范围和完整的肩胛下肌功能。恐惧征在 3 例患者（30%）中呈阳性，在 1 例患者（10%）中出现复发性半脱位。术后盂面积从术前的 84.4%（范围，73.5-92.1）显著增加到 118.4%（范围，105.6-131.2），而盂缺损从 16.2%（范围，9.2-26.5）显著减少至 0.6%（范围，0-1.6）。术后 1 年，同种异体移植物完全吸收，盂面积为 86.6%（范围，76.4-98.0），盂缺损相应增加至 14.0%（范围，2.9-23.6）。
关节镜下使用髂嵴骨移植物进行盂重建可在短期随访中获得满意的临床效果和盂肱稳定性。然而，由于移植物吸收过多，该手术并未观察到盂凹的解剖重建。
IV 级，病例系列，治疗研究。
