Belangero Paulo Santoro, Lara Paulo Henrique Schmidt, Figueiredo Eduardo Antônio, Andreoli Carlos Vicente, de Castro Pochini Alberto, Ejnisman Benno, Smith Ricardo Luiz
Universidade Federal de São Paulo (UNIFESP), Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do esporte (CETE), São Paulo, SP, Brazil.
Departamento de Morfologia e Genética da Universidade Federal de São Paulo, São Paulo, SP, Brazil.
JSES Int. 2021 Jan 12;5(2):165-170. doi: 10.1016/j.jseint.2020.11.004. eCollection 2021 Mar.
Traumatic anterior shoulder instability is a common disease, especially in young athletes. The Latarjet and Bristow techniques are nonanatomical surgeries that involve the transfer of the coracoid process to the anterior border of the glenoid and are indicated in cases at a high risk for recurrence and in the presence of associated bone lesions. Studies have evaluated the recurrence and complications associated with these techniques, but they have important differences, and should not be considered synonymous. The objective of this study was to prospectively compare the Bristow and Latarjet techniques in high-demand athletes. Hypothesis: Bristow and Latarjet techniques lead to similar results.
Thirty-seven athletes (41 shoulders; three athletes underwent bilateral surgery) with anterior recurrent dislocation of the shoulder that was surgically treated using the Bristow or Latarjet technique were prospectively analyzed. The follow-up time was 5 years. The mean age was 26.4 years (range: 16-46 years). In 17 cases (41.5%), the dominant side was not affected.
Elevation and external rotation (passive and active) decreased in the early postoperative period and achieved values in the final follow-up similar to those found in the preoperative period. The mean postoperative scores at 5 years were as follows: ASES, 79.1 (range: 66-95); ASORS, 77.8 (range: 60-100); WOSI, 52.6 (range: 18-77); and VAS, 1.88 (range: 0-6). All of the results presented statistical significance. There was a complication rate of 9.75% in the follow-up period. There were no new dislocations after the surgery. Most (75%) of the athletes returned to the sport after the surgery, and there was no correlation between poor results and any of the variables studied. There was a statistically significant difference in passive external rotation in favor of the Latarjet technique four weeks after surgery ( = .01). We also found a statistically significant difference in passive elevation in favor of the Latarjet technique eight weeks after the surgery ( = .04). When we compared the Bristow and Latarjet techniques regarding the ASES, ASORS, and WOSI scores, we found no statistically significant difference. In the comparison regarding whether the athletes returned to sports, we found no statistically significant difference.
The Bristow and Latarjet techniques lead to good results in athletes with no new dislocation episodes and are suitable for treating patients with anterior recurrent dislocation of the shoulder. The Latarjet technique showed better results in some of the variables studied.
创伤性前肩关节不稳是一种常见疾病，尤其在年轻运动员中。Latarjet和Bristow技术是非解剖学手术，涉及将喙突转移至关节盂前缘，适用于复发风险高及存在相关骨病变的病例。已有研究评估了这些技术相关的复发情况和并发症，但它们存在重要差异，不应被视为同义词。本研究的目的是前瞻性比较Bristow和Latarjet技术在高需求运动员中的效果。假设：Bristow和Latarjet技术导致相似的结果。
对37名运动员（41个肩关节；3名运动员接受了双侧手术）进行前瞻性分析，这些运动员的肩关节前复发性脱位采用Bristow或Latarjet技术进行手术治疗。随访时间为5年。平均年龄为26.4岁（范围：16 - 46岁）。17例（41.5%）中患侧为非优势侧。
术后早期抬高和外旋（被动和主动）降低，最终随访时达到与术前相似的值。术后5年的平均评分如下：美国肩肘外科医师协会（ASES）评分，79.1（范围：66 - 95）；美国肩肘外科医师协会患者自评评分（ASORS），77.8（范围：60 - 100）；西澳大利亚肩部指数（WOSI），52.6（范围：18 - 77）；视觉模拟评分（VAS），1.88（范围：0 - 6）。所有结果均具有统计学意义。随访期间并发症发生率为9.75%。术后无新的脱位发生。大多数（75%）运动员术后重返运动，结果不佳与所研究的任何变量之间均无相关性。术后4周，被动外旋方面Latarjet技术具有统计学显著优势（P = 0.01）。我们还发现术后8周，被动抬高方面Latarjet技术具有统计学显著优势（P = 0.04）。比较Bristow和Latarjet技术的ASES、ASORS和WOSI评分时，未发现统计学显著差异。比较运动员是否重返运动时，也未发现统计学显著差异。
Bristow和Latarjet技术在运动员中取得了良好效果，无新的脱位发作，适用于治疗肩关节前复发性脱位患者。Latarjet技术在一些研究变量中显示出更好的结果。
