Callegari Jonathan J, McGarry Michelle, Crook Loren, Adamson Nicholas A, Fraipont Genevieve M, Provencher Matthew, Lee Thay Q, Denard Patrick J
Oregon Shoulder Institute, Medford, Oregon, U.S.A.
Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A.
Arthroscopy. 2022 Sep;38(9):2609-2617. doi: 10.1016/j.arthro.2022.03.018. Epub 2022 Mar 25.
The purpose of this study was to compare glenohumeral stability following a Latarjet, a free bone block (FBB), and a FBB with remplissage for bipolar bone loss.
Nine matched pairs of fresh frozen cadavers were tested in a custom biomechanical apparatus with rotation and progressive translational loading. The free bone block group consisted of a distal tibial allograft with an all-suture tape construct. The Latarjet group was performed with the native coracoid and two partially threaded cannulated screws. A bipolar bone loss model was created with 20% glenoid bone loss and an off-track Hill-Sachs lesion. Testing conditions included the 1) native state, 2) bipolar bone loss model, 3) Latarjet, 4) FBB with distal tibial allograft secured with cerclage sutures, and 5) FBB with remplissage. Each condition was tested for translation, humeral head apex shift, stiffness, and dislocation force.
There were no differences in translation, stiffness, or dislocation forced between the FBB alone and Latarjet groups. The FBB with remplissage group demonstrated the lowest anterior-inferior translation at 90° of ER, which was statistically significant compared to Latarjet 20N (P = .013) and compared to the FBB alone at 40N (P = .024) and 50N (P = .011). The FBB with remplissage group was significantly stiffer compared to FBB alone at 90° ER with approximately 60% change in stiffness (P = .028). The force required to dislocate the humeral head after treatment was highest in the FBB with remplissage group, which was statistically significant compared to the FBB alone (P = .003) and Latarjet groups (P = .018).
The addition of remplissage to a FBB restores translation and stiffness closer to the intact state compared to a FBB alone or Latarjet in a bipolar bone loss model with an off-track Hill-Sachs lesion. In this model, dislocation force significantly increased with the addition of remplissage to the FBB.
This biomechanical study provides evidence that Latarjet and FBB are both acceptable forms of treatment for bipolar bone loss, but stability can be enhanced with the addition of remplissage following glenoid reconstruction.
本研究旨在比较Latarjet手术、游离骨块（FBB）以及用于双极骨缺损的带骨填充的FBB术后的盂肱关节稳定性。
使用定制的生物力学装置，对9对匹配的新鲜冷冻尸体进行旋转和渐进平移加载测试。游离骨块组由带全缝线带结构的异体胫骨远端移植组成。Latarjet组采用自体喙突和两枚部分螺纹空心螺钉进行手术。创建一个双极骨缺损模型，模拟20%的关节盂骨缺损和非轨迹性Hill-Sachs损伤。测试条件包括：1）原始状态；2）双极骨缺损模型；3）Latarjet手术；4）用环扎缝线固定异体胫骨远端移植的FBB；5）带骨填充的FBB。对每种情况进行平移、肱骨头顶点移位、刚度和脱位力测试。
单纯FBB组和Latarjet组在平移、刚度或脱位力方面没有差异。带骨填充的FBB组在90°外旋时前下平移最低，与Latarjet组在20N时相比具有统计学意义（P = 0.013），与单纯FBB组在40N（P = 0.024）和50N（P = 0.011）时相比也具有统计学意义。带骨填充的FBB组在90°外旋时比单纯FBB组明显更硬，刚度变化约60%（P = 0.028）。治疗后使肱骨头脱位所需的力在带骨填充的FBB组中最高，与单纯FBB组（P = 0.003）和Latarjet组（P = 0.018）相比具有统计学意义。
在伴有非轨迹性Hill-Sachs损伤的双极骨缺损模型中，与单纯FBB或Latarjet相比，带骨填充的FBB能使平移和刚度恢复到更接近完整状态。在该模型中，带骨填充的FBB显著增加了脱位力。
这项生物力学研究提供了证据，表明Latarjet手术和FBB都是治疗双极骨缺损可接受的方法，但在关节盂重建后增加骨填充可增强稳定性。
