Gallagher Forrest, Wong Ivan Ho-Bun
Medical School, Dalhousie University, Halifax, Nova Scotia, Canada.
Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Arthrosc Tech. 2020 Apr 25;9(5):e657-e662. doi: 10.1016/j.eats.2020.01.020. eCollection 2020 May.
Recurrent multidirectional shoulder instability is a common clinical presentation in certain demographics and sporting groups. One such demographic is patients with connective tissue disorders (CTD) such as Ehlers-Danlos syndrome (EDS), in whom shoulder pathologies are exacerbated owing to ligamentous laxity. Features of this laxity can present as both anterior and posterior shoulder instability, which are problematic sources of shoulder pain. Many patients with these injuries require surgical anterior and/or posterior glenohumeral reconstruction. Surgical reconstruction for posterior capsular defects can be challenging and has higher failure rates compared with anterior capsular reconstruction methods. Management can be especially difficult for patients with CTDs, and there is a requirement for the development of novel surgical techniques. Human acellular dermal allografts have been found to be particularly useful for patients with CTDs compared with other methods that use the patient's own tissue for the repair. This note and surgical video describe an all-arthroscopic technique for a combined anterior capsule augmentation and posterior glenohumeral capsular reconstruction, using a human acellular dermal allograft for EDS patients with multidirectional instability.
复发性多向性肩关节不稳是某些特定人群和运动群体中常见的临床表现。其中一类人群是患有结缔组织病（CTD）的患者，如埃勒斯-当洛综合征（EDS），由于韧带松弛，这类患者的肩部病变会加重。这种松弛的特征可表现为肩关节前向和后向不稳，这是肩部疼痛的问题根源。许多此类损伤的患者需要进行手术，对肩关节盂肱关节进行前侧和/或后侧重建。与前侧关节囊重建方法相比，后侧关节囊缺损的手术重建具有挑战性且失败率更高。对于患有结缔组织病的患者，治疗可能尤其困难，因此需要开发新的手术技术。与其他使用患者自身组织进行修复的方法相比，已发现人脱细胞真皮同种异体移植物对患有结缔组织病的患者特别有用。本笔记和手术视频描述了一种全关节镜技术，用于联合前侧关节囊增强和后侧肩关节盂关节囊重建，使用人脱细胞真皮同种异体移植物治疗患有多向性不稳的EDS患者。
