Peterson Eric E, Caldwell Paul E, Pearson Sara E
Orthopaedic Research of Virginia, Richmond, Virginia, U.S.A.
Tuckahoe Orthopaedic Associates, Richmond, Virginia, U.S.A.
Arthrosc Tech. 2021 Sep 21;10(10):e2325-e2330. doi: 10.1016/j.eats.2021.07.010. eCollection 2021 Oct.
Cartilage defects of the humeral head in young, active patients provide a challenge to treating surgeons. The causes of humeral head osteochondral lesions are variable, but these lesions most commonly result from trauma and recurrent glenohumeral instability. Palliative and reparative techniques such as arthroscopic debridement and microfracture have traditionally been used as surgical treatment but have high failure rates. Similarly to surgical trends in the knee, cartilage restoration in the shoulder is becoming more prevalent in younger patients. Osteochondral allograft transplantation (OAT) has been used as a joint-preserving surgical option to restore hyaline cartilage in multiple joints for decades. Although OAT is more commonly used to re-establish the subchondral bony architecture in the treatment of recurrent shoulder instability, the procedure may also be indicated in young, active patients with focal humeral head chondral defects. OAT has been shown in early studies to provide improvement in functional outcome scores and good long-term graft survival with relatively low rates of complications. This report describes our straightforward, reproducible technique for the treatment of large, oblong chondral defects of the humeral head using OAT.
对于年轻、活跃的患者，肱骨头软骨缺损给治疗外科医生带来了挑战。肱骨头骨软骨损伤的病因多种多样，但这些损伤最常见的原因是创伤和复发性肩肱关节不稳定。传统上，诸如关节镜清创术和微骨折术等姑息性和修复性技术一直被用作手术治疗方法，但失败率很高。与膝关节的手术趋势类似，肩部软骨修复在年轻患者中越来越普遍。几十年来，骨软骨同种异体移植（OAT）一直被用作一种保留关节的手术选择，以恢复多个关节的透明软骨。虽然OAT更常用于在复发性肩关节不稳定的治疗中重建软骨下骨结构，但该手术也可能适用于患有局限性肱骨头软骨缺损的年轻、活跃患者。早期研究表明，OAT可改善功能结果评分，移植长期存活率良好，并发症发生率相对较低。本报告描述了我们使用OAT治疗肱骨头大的、长方形软骨缺损的简单、可重复的技术。
