Huish Eric G, Kelly Shayne R, Cutter Brenden M
San Joaquin General Hospital, French Camp, CA, USA.
Valley Orthopedic Surgery Residency, Modesto, CA, USA.
Shoulder Elbow. 2022 Feb;14(1):17-23. doi: 10.1177/1758573220960462. Epub 2020 Sep 21.
The Latarjet procedure reduces recurrent glenohumeral instability but has potential hardware and graft complications. The procedure has been modified to use various screw types as well as suture buttons. Biomechanical studies have evaluated the effect of these implants on construct strength. With varying results it is unclear whether there is an optimal implant to use.
We conducted a systematic review of human cadaveric biomechanical studies evaluating Latarjet ultimate failure load. Two independent reviewers screened articles and included them after full text review. Additional factors including implants used, graft orientation, cortices engaged, drill diameter, and screw characteristics were recorded. Meta-regression was performed on the 145 specimens from eight studies that met inclusion criteria.
Screw fixation resulted in a 396.8 N (95% CI, 149.8-643.7) N higher ultimate failure load against shear stresses than suture buttons (p = 0.002). There were no differences between implants for ultimate failure load against tensile forces. Tensile strength was significantly affected by drill diameter with each millimeter of increase reducing the mean ultimate failure load by 127.4 N (95% CI, 41.2-213.6) N (p = 0.004).
These results suggest that using screw fixation and minimizing drill diameter can obtain the maximum ultimate failure load against both shear and tensile forces in a Latarjet construct.
Latarjet手术可降低复发性盂肱关节不稳的发生率，但存在潜在的硬件和移植物并发症。该手术已进行改良，可使用多种螺钉类型以及缝线纽扣。生物力学研究评估了这些植入物对结构强度的影响。由于结果各异，目前尚不清楚是否存在最佳的植入物可供使用。
我们对评估Latarjet最终破坏载荷的人体尸体生物力学研究进行了系统综述。两名独立的评审员筛选文章，并在全文评审后纳入。记录了包括使用的植入物、移植物方向、皮质参与情况、钻孔直径和螺钉特性等其他因素。对符合纳入标准的八项研究中的145个标本进行了Meta回归分析。
与缝线纽扣相比，螺钉固定在抗剪切应力方面的最终破坏载荷高396.8 N（95%可信区间，149.8 - 643.7）N（p = 0.002）。在抗拉力的最终破坏载荷方面，植入物之间没有差异。拉伸强度受钻孔直径的显著影响，每增加一毫米，平均最终破坏载荷降低127.4 N（95%可信区间，41.2 - 213.6）N（p = 0.004）。
这些结果表明，在Latarjet结构中，使用螺钉固定并尽量减小钻孔直径可在抗剪切力和抗拉力方面获得最大的最终破坏载荷。
