Cusano Antonio, Do Andrew, Parisien Robert L, Li Xinning
Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut.
Department of Orthopaedic Surgery, Boston University Medical School and Medical Center, Boston, Massachusetts.
Arthrosc Tech. 2021 Feb 24;10(2):e341-e351. doi: 10.1016/j.eats.2020.10.018. eCollection 2021 Feb.
Posterior glenohumeral instability is a relatively uncommon cause of shoulder instability. Recurrent posterior instability with static posterior humeral head subluxation is often associated with critical glenoid bone loss. Unlike anterior instability, the amount of bone loss for posterior instability that requires surgical reconstruction remains a topic of debate. Several techniques have been described to treat critical bony defects in patients with recurrent posterior shoulder instability with the use of both autografts and allografts depending on the amount of bone loss present. Open posterior glenoid bone block procedure is associated with increased risk of complications and morbidity to the patient. As such, all-arthroscopic techniques have emerged with the advantage of allowing for the diagnosis and treatment of concomitant glenohumeral pathology and minimizing soft-tissue dissection through the posterior deltoid and rotator cuff muscles. Reported short-term outcomes of arthroscopic posterior bone block stabilization are promising; however, it remains a technically challenging procedure due to intra-articular graft insertion and subsequent fixation congruent to the posterior glenoid articular margin. We describe an all-arthroscopic technique using a fresh distal tibia allograft fixation using 2 partially threaded screws in conjunction with an arthroscopic Latarjet fixation set for a patient with recurrent posterior shoulder instability and associated glenoid bone loss.
肩肱关节后向不稳是肩部不稳相对少见的原因。复发性后向不稳伴肱骨头静态半脱位常与关键的肩胛盂骨质流失相关。与前向不稳不同，对于需要手术重建的后向不稳，骨质流失的量仍是一个有争议的话题。已经描述了几种技术来治疗复发性肩后向不稳患者的关键骨缺损，根据存在的骨质流失量，可使用自体骨移植和同种异体骨移植。开放肩胛盂骨块手术会增加患者并发症和发病率的风险。因此，全关节镜技术应运而生，其优点是能够诊断和治疗合并的肩肱关节病变，并通过后三角肌和肩袖肌肉将软组织剥离减至最少。关节镜下后骨块稳定术的短期疗效令人期待；然而，由于关节内移植物的插入以及随后与肩胛盂后关节边缘的固定，它仍然是一项技术上具有挑战性的手术。我们描述了一种全关节镜技术，该技术使用新鲜的胫骨远端同种异体骨，通过2枚部分螺纹螺钉固定，并结合关节镜Latarjet固定装置，用于治疗一名复发性肩后向不稳并伴有肩胛盂骨质流失的患者。
