Alfaraidy Moaad, Alraiyes Thamer, Moatshe Gilbert, Litchfield Robert, LeBel Marie-Eve
Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada; Medical Cities, General Directorate of Medical Services, Ministry of Interior, Riyadh, Saudi Arabia.
Roth | McFarlane Hand and Upper Limb Centre, Western University, London, ON, Canada; Department of Orthopaedics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
J Shoulder Elbow Surg. 2023 Jan;32(1):41-49. doi: 10.1016/j.jse.2022.06.004. Epub 2022 Jul 21.
To report on intraoperative and short-term postoperative adverse events after open Latarjet procedure in patients with recurrent anterior shoulder instability. These complications were classified into different grades of severity based on the treatment required and the learning curve of the procedure.
Ninety-six patients (102 shoulders) underwent open Latarjet procedure for recurrent post-traumatic anterior glenohumeral instability between 2012 and 2020. The minimum duration of patients' follow-up was 6 months. Adverse events were classified into 3 classes based on the severity and subsequent treatment. The complications in the first 50% of all cases were compared with the latter 50% to evaluate the role of learning curve on the complication rates.
The mean follow-up was 7.2 ± 2.8 months. The patients' mean age was 26.7 ± 8.9 years and consisted of 83 (86.4%) male and 13 (13.6%) female patients. The total adverse events rate was 18.6%. Adverse events requiring no additional treatment (class 1) occurred in 6 cases (5.8%) including fibrous union (3.9%) and asymptomatic resorption of the graft (1.9%). Adverse events requiring additional or extended nonoperative management (class 2) occurred in 8 cases (7.8%), including coracoid fracture (2.9%), musculocutaneous nerve palsy (1.9%), axillary nerve palsy (0.9%), suprascapular nerve palsy (0.9%), and stiffness (0.9%). All the nerve palsies recovered without long-term sequelae. Adverse events requiring secondary operative procedures (class 3) occurred in 5 cases (4.9%), including symptomatic hardware (1.9%), medial healing of the graft (0.9%), screw loosening (0.9%), and deep infection (0.9%). The rate of adverse events in revision cases was higher than primary cases in 11.7% and 6.8%, respectively (P = .119). The complication rate was significantly higher in the first half of the surgeons' practice (14.7%) than in the second half (3.9%) (P ≤ .05).
The overall complication rate reported in this open Latarjet series is 18.6%; however, the rate of class 3 adverse events that required additional surgery or long-term medical treatment was only 4.9%. Revision cases had a higher rate of complications than primary cases, and the learning curve has had a significant impact on the rate of adverse events.
报告复发性肩关节前脱位患者行切开Latarjet手术的术中及术后短期不良事件。根据所需治疗及手术学习曲线，将这些并发症分为不同严重程度等级。
2012年至2020年期间，96例患者（102个肩关节）因创伤后复发性肩关节前脱位接受了切开Latarjet手术。患者的最短随访时间为6个月。根据严重程度及后续治疗将不良事件分为3类。比较所有病例中前50%与后50%的并发症，以评估学习曲线对并发症发生率的影响。
平均随访时间为7.2±2.8个月。患者的平均年龄为26.7±8.9岁，其中男性83例（86.4%），女性13例（13.6%）。总不良事件发生率为18.6%。无需额外治疗的不良事件（1级）有6例（5.8%），包括纤维性愈合（3.9%）和移植骨无症状吸收（1.9%）。需要额外或延长非手术治疗的不良事件（2级）有8例（7.8%），包括喙突骨折（2.9%）、肌皮神经麻痹（1.9%）、腋神经麻痹（0.9%）、肩胛上神经麻痹（0.9%）和僵硬（0.9%）。所有神经麻痹均恢复，无长期后遗症。需要二次手术的不良事件（3级）有5例（4.9%），包括有症状的内固定物（1.9%）、移植骨内侧愈合（0.9%）、螺钉松动（0.9%）和深部感染（0.9%）。翻修病例和初次手术病例的不良事件发生率分别为11.7%和6.8%（P = 0.119）。外科医生手术前半段的并发症发生率（14.7%）显著高于后半段（3.9%）（P≤0.05）。
本切开Latarjet手术系列报告的总体并发症发生率为18.6%；然而，需要额外手术或长期药物治疗的3级不良事件发生率仅为4.9%。翻修病例的并发症发生率高于初次手术病例，学习曲线对不良事件发生率有显著影响。
