Boutsiadis Achilleas, Bampis Ioannis, Swan John, Barth Johannes
Department of Orthopedic Surgery, 401 Military Hospital of Athens, Athens, Greece.
Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Parc sud galaxie, 5 Rue Des Tropiques, 38130 Echirolles, Grenoble, France.
J Exp Orthop. 2020 Mar 17;7(1):15. doi: 10.1186/s40634-020-00230-0.
To assess the anthropometric dimensions of the coracoid process and the glenoid articular surface and to determine possible implications with the different commercially available Latarjet fixation techniques.
In a total of 101 skeletal scapulae the glenoid length (GL), the glenoid width (GW), the coracoid length (CL), the coracoid width (CW) and the coracoid thickness (CTh) were measured. In order to assess the ability of the transferred coracoid to restore the glenoid anatomy we created a hypothetical model of 10%, 15%, 20%, 25% and 30% glenoid bone loss. We analyzed four common surgical fixation techniques for the Latarjet procedure (4.5 mm screws, 3.75 mm screws, 3.5 mm screws, and 2.8 mm button). The distances from the superior-inferior and medio-lateral limits of the coracoid using the four different fixation methods were calculated. We hypothesized that the "safe distance" between the implant and the coracoid osteotomy should be at least equal to the diameter of the implant.
The intra and inter-observer reliability tests were almost perfect for all measurements. The mean GH was 36.8 ± 2.5 mm, the GW 26.4 ± 2.2 mm, the CL 23.9 ± 3 mm, the CW 13.6 ± 2.mm, and the mean CTh was 8.7 ± 1.3 mm. The CL was < 25 mm in 46% of the cases. In cases with 25% and 30% bone loss, the coracoid graft restored the glenoid anatomy in 96% and 79.2% of the cases. With the use of the 4.5 mm screws the "safe distance" was present in 56% of the cases, with the 3.75 mm screws in 85%, with the 3.5 mm screws in 87%, and with the 2.8 mm button in 98% of the cases. The distance from the medio-lateral limit of the coracoid could be significantly increased (up to 9 mm) when smaller-button implants are used.
The coracoid graft could not always restore glenoid defects of 30%. Larger implants could be positioned too close to the osteotomy and the "medio-lateral offset" of the coracoid could be increased with smaller implants.
评估喙突和关节盂关节面的人体测量尺寸，并确定不同市售Latarjet固定技术可能产生的影响。
对总共101具肩胛骨测量关节盂长度（GL）、关节盂宽度（GW）、喙突长度（CL）、喙突宽度（CW）和喙突厚度（CTh）。为了评估转移的喙突恢复关节盂解剖结构的能力，我们创建了10%、15%、20%、25%和30%关节盂骨缺损的假设模型。我们分析了Latarjet手术的四种常见手术固定技术（4.5毫米螺钉、3.75毫米螺钉、3.5毫米螺钉和2.8毫米纽扣）。计算了使用四种不同固定方法时距喙突上下和内外边界的距离。我们假设植入物与喙突截骨术之间的“安全距离”应至少等于植入物的直径。
所有测量的观察者内和观察者间可靠性测试几乎完美。平均GL为36.8±2.5毫米，GW为26.4±2.2毫米，CL为23.9±3毫米，CW为13.6±2毫米，平均CTh为8.7±1.3毫米。46%的病例中CL<25毫米。在骨缺损25%和30%的病例中，喙突移植在96%和79.2%的病例中恢复了关节盂解剖结构。使用4.5毫米螺钉时，56%的病例存在“安全距离”；使用3.75毫米螺钉时，85%的病例存在；使用3.5毫米螺钉时，87%的病例存在；使用2.8毫米纽扣时，98%的病例存在。使用较小纽扣植入物时，距喙突内外边界的距离可显著增加（达9毫米）。
喙突移植并非总能修复30%的关节盂缺损。较大的植入物可能放置得离截骨术太近，较小的植入物可能会增加喙突的“内外偏移”。
