Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
J Shoulder Elbow Surg. 2021 Jun;30(6):e300-e308. doi: 10.1016/j.jse.2020.09.002. Epub 2020 Sep 30.
The Latarjet procedure is an effective procedure for the treatment of anterior glenohumeral joint instability; however, the complications are concerning. The purpose of this study was to review a single institution's experience with the Latarjet procedure for recurrent anterior glenohumeral instability specifically focusing on early complications.
This was a retrospective review of all Latarjet procedures performed at a single institution from August 2008 to July 2018. The 90-day complication rate and associated risk factors for all complications and graft failure were recorded. Postoperative radiographs were reviewed for coracoid graft position and screw divergence.
During the study period, 190 Latarjet procedures were performed with 90-day follow-up. The average age was 28.7 ± 11.3 years, male patients comprised 84.2% of the population, and 62.6% of patients had undergone a prior stabilization procedure. We observed 15 complications, for a 90-day complication rate of 9.0%; of the patients, 8 (4.2%) underwent reoperations. Graft or hardware failure occurred in 9 patients (4.7%) with loosened or broken screws, and 6 required reoperations (revision Latarjet procedure in 4, distal tibia allograft in 1, and iliac crest autograft in 1). Fixation with only 1 screw (P < .001) and an increased screw divergence angle (37° ± 8° vs. 24° ± 11°, P = .0257) were statistically associated with graft failure, whereas the use of cannulated screws (P = .487) was not. There were 6 nerve injuries (3.2%), including 2 combined axillary and suprascapular nerve injuries, 1 musculocutaneous nerve injury, 1 brachial plexopathy, 1 peripheral sensory nerve deficit (likely axillary), and 1 sensory plexopathy. Suprascapular nerve injury at the spinoglenoid notch was associated with a longer superior screw (41.0 ± 1.4 mm vs. 33.5 ± 3.5 mm, P = .035) and increased screw divergence angle (40° ± 6° vs. 24° ± 11°, P = .0197). The coracoid graft was correctly positioned in the axial plane in 71% of cases and in the coronal plane in 73% of cases.
The Latarjet procedure is a procedure that can reliably restore shoulder stability; however, graft- and nerve-related complications are relatively common. Two-thirds of the graft failures required reoperations, and half of the nerve injuries in this study led to residual symptoms. Fixation with only 1 screw and an increased screw divergence angle were significant predictors of graft failure. Suprascapular nerve injury at the spinoglenoid notch was associated with an increased screw divergence angle and longer superior screw.
Latarjet 手术是治疗前肩盂关节不稳定的有效方法，但并发症令人担忧。本研究的目的是回顾单中心 Latarjet 手术治疗复发性前肩盂关节不稳定的经验，特别是关注早期并发症。
这是对 2008 年 8 月至 2018 年 7 月在一家单中心进行的所有 Latarjet 手术的回顾性研究。记录所有并发症和移植物失败的 90 天并发症发生率和相关危险因素。术后 X 线片评估喙突移植物位置和螺钉发散情况。
研究期间，190 例患者接受了 Latarjet 手术，随访 90 天。平均年龄为 28.7 ± 11.3 岁，男性患者占 84.2%，62.6%的患者曾接受过稳定化手术。我们观察到 15 例并发症，90 天并发症发生率为 9.0%；其中 8 例（4.2%）患者接受了再次手术。9 例患者发生移植物或硬件失败（4.7%），表现为松动或断裂的螺钉，其中 6 例需要再次手术（4 例为翻修 Latarjet 手术，1 例为胫骨远端同种异体移植物，1 例为髂嵴自体移植物）。仅用 1 枚螺钉固定（P <.001）和螺钉发散角增加（37° ± 8° vs. 24° ± 11°，P =.0257）与移植物失败有统计学关联，而使用空心螺钉（P =.487）则没有。有 6 例神经损伤（3.2%），包括 2 例腋神经和肩胛上神经同时损伤，1 例肌皮神经损伤，1 例臂丛神经病，1 例周围感觉神经缺损（可能为腋神经）和 1 例感觉神经丛病。肩胛上神经在肩胛下切迹处损伤与上螺钉较长（41.0 ± 1.4mm vs. 33.5 ± 3.5mm，P =.035）和螺钉发散角增加（40° ± 6° vs. 24° ± 11°，P =.0197）有关。喙突移植物在轴向平面的正确位置为 71%，在冠状平面的正确位置为 73%。
Latarjet 手术是一种能够可靠恢复肩部稳定性的手术，但与移植物和神经相关的并发症相对常见。三分之二的移植物失败需要再次手术，本研究中一半的神经损伤导致残留症状。仅用 1 枚螺钉固定和螺钉发散角增加是移植物失败的显著预测因素。肩胛上神经在肩胛下切迹处损伤与螺钉发散角增加和上螺钉较长有关。
