Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Department of Orthopaedic Surgery, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
Am J Sports Med. 2020 Nov;48(13):3316-3321. doi: 10.1177/0363546520960119. Epub 2020 Oct 12.
The all-arthroscopic anatomic glenoid reconstruction technique using a distal tibial allograft avoids damage to the subscapularis muscle and allows repair of the capsulolabral tissue.
To analyze the clinicoradiologic outcomes of patients who underwent this procedure to treat anterior shoulder instability with glenoid bone loss with a minimum 2-year follow-up.
Case series; Level of evidence, 4.
Over 6 years, 73 patients (52 male and 21 female; mean age, 28.8 years) under the care of the same surgeon underwent arthroscopic stabilization with capsulolabral Bankart repair and bony allograft augmentation of the glenoid for recurrent shoulder instability with significant bone loss. Pre- and postoperative patient-reported functional assessment was performed using 2 questionnaires, the Western Ontario Shoulder Instability Index (WOSI) and the Disabilities of the Arm, Shoulder and Hand, and radiological assessment was performed using radiographs and computed tomography scans obtained preoperatively and approximately 1 year later (mean ± SD, 0.9 ± 1.1 years).
The mean follow-up was 4.7 ± 1.1 years. The mean pre- and postoperative WOSI scores were 71.1 ± 17.5 and 25.6 ± 21.9, respectively ( < .001). There were no recurrences of dislocation, although 1 patient had symptoms of subluxation; however, 5 patients had hardware complications that required screw removal. There were no cases of nerve injury. Postoperative computed tomography scans were available for 66 patients. Seven patients were lost to follow-up. The graft union rate was 100%. Overall, graft resorption was <50% in 86% of patients (57/66). Eighteen patients (27%) had no resorption (grade 0), 39 (59%) had <50% (grades 1 and 2), and 9 (14%) had ≥50% (grade 3); however, none had symptoms of instability. The mean alpha angle of the screw between the screw shaft axis and the native glenoid axis was 18.3°± 5.7°. Graft positioning was flush with the glenoid in 61 of 66 patients (92.4%), and vertical positioning was excellent in 64 of 66 patients (97.0%) (3- to 5-o'clock position).
Arthroscopic stabilization using distal tibial allograft augmentation resulted in excellent clinicoradiologic outcomes at a 2-year follow-up. This procedure has the advantages of being an anatomic reconstruction that addresses bony and soft tissue instability. However, long-term follow-up studies are necessary for better assessment of outcomes.
使用远端胫骨同种异体移植物进行全关节镜下解剖盂唇重建技术可避免肩胛下肌损伤，并允许修复肩袖盂唇复合体组织。
分析采用该方法治疗伴有盂肱关节骨缺损的复发性肩关节前不稳定患者的临床和影像学结果，随访时间至少为 2 年。
病例系列；证据等级，4 级。
在同一位外科医生的治疗下，超过 6 年的时间里，73 名患者（52 名男性和 21 名女性；平均年龄 28.8 岁）接受了关节镜下稳定术，包括盂唇Bankart 修复和骨盂唇盂肱关节骨缺损的同种异体移植物增强术，以治疗复发性肩关节不稳定伴明显骨丢失。使用 Western Ontario 肩不稳定指数（WOSI）和上肢残疾问卷（DASH）对术前和术后患者的功能进行了报告，影像学评估使用术前和术后约 1 年（平均±标准差，0.9±1.1 年）获得的 X 线片和 CT 扫描进行。
平均随访时间为 4.7±1.1 年。术前和术后 WOSI 评分分别为 71.1±17.5 和 25.6±21.9（<0.001）。虽然 1 名患者有半脱位症状，但无脱位复发，5 名患者出现了需要取出内固定螺钉的硬件并发症。无神经损伤病例。66 名患者中有 64 名患者获得了术后 CT 扫描。7 名患者失访。移植物愈合率为 100%。总体而言，86%（57/66）的患者移植物吸收<50%（等级 0），59%（39/66）的患者移植物吸收<50%（等级 1 和 2），14%（9/66）的患者移植物吸收≥50%（等级 3），但无患者出现不稳定症状。螺钉轴与固有盂肱关节轴之间的螺钉阿尔法角为 18.3°±5.7°。66 例患者中，61 例（92.4%）的移植物位置与盂唇平齐，66 例患者中，64 例（97.0%）的移植物位置垂直（3 点至 5 点位置）良好。
在 2 年随访时，使用远端胫骨同种异体移植物增强的关节镜下稳定术取得了优异的临床影像学结果。该手术具有进行解剖重建的优点，可解决骨和软组织不稳定的问题。但是，需要进行长期的随访研究以更好地评估结果。
