Nabergoj Marko, Zumstein Matthias, Denard Patrick J, Collin Philippe, Ho Sean Wei Loong, Wang Sidi, Lädermann Alexandre
Valdoltra Orthopaedic Hospital, Ankaran, Slovenia.
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Arthrosc Tech. 2021 Oct 6;10(11):e2397-e2406. doi: 10.1016/j.eats.2021.07.017. eCollection 2021 Nov.
Surgical treatment of anterior glenohumeral joint instability can be challenging and carries the inherent risk of recurrent instability, dislocation arthropathy, and postoperative loss of external rotation. In the current manuscript, a technique for combined reconstruction of anterior labrum and capsule, with concomitant reduction of the humeral head during anterior capsule reconstruction in open Latarjet procedure, is presented. Analogous to other techniques, the coracoid graft is fixed on the anteroinferior part of the glenoid between 3 and 5 o'clock. However, for this technique, reattachment of the labrum is performed between the native glenoid and the bone graft. Additionally, during the reconstruction of the anterior capsule on the coracoacromial ligament, while the operated arm is held in external rotation to avoid the postoperative rotational deficit, the humeral head is reduced posteriorly in the center of the glenoid during adduction, slight anterior forward flexion, and a posterior lever push. By doing so, the inherent theoretical risks of persistent instability and dislocation arthropathy are believed to be decreased. Further studies are needed to clarify the long-term consequences of this surgical technique in the clinical setting.
肩关节前向不稳的手术治疗具有挑战性，且存在复发性不稳、脱位性关节病及术后外旋丧失等固有风险。在本论文中，介绍了一种在开放性Latarjet手术中，在前关节囊重建时联合重建前盂唇和关节囊，并同时复位肱骨头的技术。与其他技术类似，喙突移植物固定于肩胛盂前下部3点至5点位置。然而，对于该技术，盂唇的重新附着是在天然肩胛盂与骨移植物之间进行的。此外，在喙肩韧带上前关节囊重建过程中，当患侧上肢保持外旋以避免术后旋转功能障碍时，在内收、轻度前屈及向后杠杆推挤动作下，肱骨头在肩胛盂中心向后复位。通过这样做，持续性不稳和脱位性关节病的固有理论风险被认为会降低。需要进一步研究以阐明该手术技术在临床环境中的长期后果。
