Upper Limb Department, Sichuan Provincial Orthopaedic Hospital, Chengdu.
Shoulder Service, Beijing Jishuitan Hospital, School of Medicine, Peking University, Beijing, China.
Arthroscopy. 2021 Jul;37(7):2065-2074. doi: 10.1016/j.arthro.2021.01.061. Epub 2021 Feb 10.
The purpose of our study is to prove that the autologous scapular spine bone graft is an alternative for the treatment of anterior shoulder instability and the clinical and radiological results are promising.
From July 2016 to August 2018, patients who were diagnosed as having anterior shoulder instability with subcritical (10%-15%) glenoid bone loss were treated by arthroscopic repair with autologous scapular spine bone graft. The inclusion criteria were (1) anterior shoulder instability underwent arthroscopic autologous scapular spine bone graft; (2) glenoid bone loss was within 10% to 15% (measured by Sugaya's method); (3) three complete sets of computed tomography (CT) scans (preoperative, 1 week after surgery, and 1 year after surgery) available; and (4) clinical follow-up time was at least 2 years. The exclusion criteria were (1) concomitant rotator cuff tear; (2) concomitant remplissage or SLAP repair; (3) previous surgery of the affected shoulder; (4) open surgery; and (5) incomplete radiological or clinical follow-up. The preoperative and postoperative Constant-Murley score, dietary approaches to stop hypertension (DASH) score, visual analog scale (VAS) score, and range of motion (ROM) were recorded. CT scans with 3-dimensional reconstruction were obtained at the first week after operation and at 1 year after operation; the graft resorption rate was consequently calculated.
Twenty-seven patients were qualified and enrolled in the study. No severe complication was recorded during follow-up. No redislocation or subluxation was found, and the apprehension tests were all negative. At the last follow-up, the mean Constant-Murley score was 89.74 ± 3.71, the mean DASH score was 9.77 ± 5.31, the mean VAS score was 0.74 ± 0.64, which are all improved significantly compared with preoperative scores (P = .00,.00,.00, respectively). At the last follow-up, the ROM including anterior flexion, external rotation by side, and the internal rotation were well restored without significant difference compared with the contralateral shoulder (P =.48, .08, .47, respectively). At 1 year after operation, the resorption rate of the bone graft was 19.4%.
This study found that anterior shoulder instability with subcritical (10%-15%) glenoid bone loss treated with arthroscopic autologous scapular spine bone graft with suture anchor fixation is safe and could achieve satisfactory result at short-term follow-up.
Therapeutic case series.
本研究旨在证明自体肩胛冈骨移植是治疗前肩不稳的一种替代方法，其临床和影像学结果有前景。
自 2016 年 7 月至 2018 年 8 月，对诊断为前肩不稳伴临界（10%-15%）肩胛盂骨缺损的患者行关节镜下自体肩胛冈骨移植修复。纳入标准为：（1）行关节镜下自体肩胛冈骨移植治疗的前肩不稳；（2）肩胛盂骨缺损为 10%至 15%（采用 Sugaya 法测量）；（3）术前、术后 1 周和术后 1 年有完整的 3 套计算机断层扫描（CT）扫描；（4）临床随访时间至少 2 年。排除标准为：（1）合并肩袖撕裂；（2）合并 remplissage 或 SLAP 修复；（3）同侧肩部既往手术史；（4）开放手术；（5）影像学或临床随访不完整。记录术前和术后的 Constant-Murley 评分、高血压膳食治疗（DASH）评分、视觉模拟评分（VAS）和活动范围（ROM）。术后第 1 周和术后 1 年进行 CT 扫描三维重建，计算移植物吸收率。
27 例患者符合条件并纳入研究。随访期间无严重并发症。无再脱位或半脱位，前抽屉试验均为阴性。末次随访时，Constant-Murley 评分平均为 89.74±3.71，DASH 评分平均为 9.77±5.31，VAS 评分平均为 0.74±0.64，与术前评分相比均有显著改善（P=0.00，0.00，0.00，分别）。末次随访时，前屈、侧方外展和内旋活动度与对侧肩部相比均得到良好恢复，差异无统计学意义（P=0.48，0.08，0.47，分别）。术后 1 年，骨移植物吸收率为 19.4%。
本研究发现，关节镜下自体肩胛冈骨移植加缝线锚定治疗临界（10%-15%）肩胛盂骨缺损的前肩不稳，在短期随访中是安全的，并可获得满意的结果。
治疗性病例系列。
