Imai Shinji
Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Japan.
JB JS Open Access. 2021 Feb 12;6(1). doi: 10.2106/JBJS.OA.20.00141. eCollection 2021 Jan-Mar.
The Latarjet procedure is a commonly used treatment for recurrent shoulder instability. However, its neurological complication rate has been reported to be as high as 10%. During the Latarjet procedure, the neurovascular structures are relocated inferiorly and medially. I hypothesized that the risk of nerve injury would be reduced by assisting the inferior-medial relocation of the neurovascular structures intraoperatively.
Seventeen consecutive patients with shoulder instability accompanied by glenoid bone loss were treated with an all-arthroscopic Latarjet procedure assisted by the novel low-profile SaSumata (SS) guide. The SS guide is inserted through a portal made above the coracoid process and is attached to the coracoid process by 2 pre-fix screws (i.e., temporary pre-fixation screws). Unlike previous techniques, the SS guide is not shuttled from 1 portal to the other to redirect the bone graft from the donor site to the recipient site; instead, it remains attached to the graft throughout the procedure. The SS guide brings the coracoid graft along an inferior-medial trajectory, pushing aside the neurovascular structures with the help of a switching stick. Owing to its semicircular pronged head, the SS guide holds the graft until the pre-fix screws are exchanged with permanent screws. All patients were clinically assessed and underwent computed tomography (CT) scans.
This maneuver was performed arthroscopically in 17 patients, with no conversion to open surgery and no neurological injuries. No patient had recurrence of dislocation after follow-up for a minimum of 24 months. The mean Subjective Shoulder Value was 87.5% ± 11.7%. The mean Rowe score was 88 ± 15.7. The bone block was optimally positioned between 3 o'clock and 5 o'clock and was flush with the glenoid facet in 16 of the 17 patients. There was 1 fracture of the bone block. The mean operation time after the first 5 patients was 125 ± 23 minutes.
The SS guide was a useful tool for performing the arthroscopically assisted Latarjet procedure for recurrent anterior shoulder instability, with good functional results.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Latarjet手术是治疗复发性肩关节不稳的常用方法。然而，据报道其神经并发症发生率高达10%。在Latarjet手术过程中，神经血管结构会向内下方移位。我推测术中辅助神经血管结构向内下方移位可降低神经损伤风险。
连续17例伴有肩胛盂骨缺损的肩关节不稳患者接受了全关节镜下Latarjet手术，该手术由新型低轮廓的SaSumata（SS）导向器辅助。SS导向器通过在喙突上方制作的一个切口插入，并通过2枚预固定螺钉（即临时预固定螺钉）固定在喙突上。与以往技术不同，SS导向器不是从一个切口穿梭到另一个切口来将骨移植块从供骨部位重新导向受骨部位；相反，在整个手术过程中它都与移植块相连。SS导向器沿着内下方轨迹引导喙突移植块，借助一根转换棒将神经血管结构推开。由于其半圆形叉状头部，SS导向器在预固定螺钉被永久螺钉替换之前一直固定着移植块。所有患者均接受临床评估并进行了计算机断层扫描（CT）。
该操作在17例患者中通过关节镜完成，无一例转为开放手术，也无神经损伤。随访至少24个月后，无患者出现脱位复发。主观肩关节评分为87.5%±11.7%。Rowe评分平均为88±15.7。17例患者中有16例骨块最佳位置在3点至5点之间且与肩胛盂关节面平齐。有1例骨块骨折。前5例患者之后的平均手术时间为125±23分钟。
SS导向器是用于复发性前肩关节不稳的关节镜辅助Latarjet手术的有用工具，功能效果良好。
治疗性IV级。有关证据水平的完整描述，请参阅作者指南。
