Department of Orthopedic Surgery, Clinica Universidad de los Andes, Santiago, Chile.
Department of Orthopedic Surgery, Hospital Militar de Santiago, Santiago, Chile.
JBJS Rev. 2022 Aug 4;10(7). doi: e22.00049. eCollection 2022 Jul 1.
»: Anterior glenohumeral instability (AGI) is a challenging condition that requires close attention to osseous and soft-tissue abnormalities. The morphometric variance of the periarticular scapular anatomy may be involved in the pathogenesis of recurrent traumatic anterior instability.
»: The Trillat procedure repositions the coracoid medially and downward by a partial wedge osteotomy, mimicking the sling effect of the Latarjet procedure by moving the conjoint tendon closer to the joint line in throwing position. The Trillat procedure decreases the coracohumeral distance without affecting the integrity of the subscapularis muscle and tendon.
»: Joint preservation methods, such as the Trillat procedure, may be explored in older patients to treat AGI with simultaneous irreparable rotator cuff tears (RCTs) with a static centered head and a functional subscapularis.
»: Shoulder hyperlaxity and instability can be challenging to treat with isolated soft-tissue procedures. In cases without glenoid bone loss, free bone block techniques are ineffective because of the subsequent potential graft resorption, apprehension, or recurrence. The Trillat surgery, in conjunction with an anteroinferior capsuloplasty, seems to be helpful in preventing recurrent instability and in reducing shoulder apprehension.
»: Recently, several variations of the original technique have been described. In the future, anatomical, biomechanical, and clinical studies need to be conducted to further evaluate the morphometric characterization of the procedure, enhance the technical features, improve indications, and avoid coracoid impingement and other potential complications with the Trillat procedure.
»: 盂肱前向不稳定（AGI）是一种具有挑战性的病症，需要密切关注骨骼和软组织异常。关节周围肩胛解剖形态的形态学差异可能与复发性创伤性前向不稳定的发病机制有关。
»: Trillat 手术通过部分楔形截骨将喙突向内侧和下方移位，通过将联合肌腱更靠近投掷位的关节线来模拟 Latarjet 手术的吊索效应。Trillat 手术减少了喙肱距离，同时不影响肩胛下肌和肌腱的完整性。
»: 关节保留方法，如 Trillat 手术，可能会在老年患者中探索，以治疗同时存在不可修复的肩袖撕裂（RCT）的 AGI，这些患者具有静态中心头和功能性肩胛下肌。
»: 肩过度松弛和不稳定可能难以通过孤立的软组织手术治疗。在没有肩胛盂骨丢失的情况下，游离骨块技术无效，因为随后可能会发生移植物吸收、恐惧或复发。Trillat 手术结合前下关节囊成形术似乎有助于预防复发性不稳定，并减少肩部恐惧。
»: 最近，已经描述了该技术的几种变体。未来，需要进行解剖学、生物力学和临床研究，以进一步评估该手术的形态学特征，增强技术特征，改善适应证，并避免喙突撞击和 Trillat 手术的其他潜在并发症。
