Hachem Abdul-Ilah, Molina-Creixell Andres, Rius Xavier, Rodriguez-Bascones Karla, Cabo Cabo Francisco Javier, Agulló Jose Luis, Ruiz-Iban Miguel Angel
Department of Orthopedic Surgery, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico.
EFORT Open Rev. 2022 Aug 4;7(8):576-586. doi: 10.1530/EOR-22-0009.
Recurrent posterior glenohumeral instability is an entity that demands a high clinical suspicion and a detailed study for a correct approach and treatment. Its classification must consider its biomechanics, whether it is due to functional muscular imbalance or to structural changes, volition, and intentionality. Due to its varied clinical presentations and different structural alterations, ranging from capsule-labral lesions and bone defects to glenoid dysplasia and retroversion, the different treatment alternatives available have historically had a high incidence of failure. A detailed radiographic assessment, with both CT and MRI, with a precise assessment of glenoid and humeral bone defects and of glenoid morphology, is mandatory. Physiotherapy focused on periscapular muscle reeducation and external rotator strengthening is always the first line of treatment. When conservative treatment fails, surgical treatment must be guided by the structural lesions present, ranging from soft tissue repair to posterior bone block techniques to restore or increase the articular surface. Bone block procedures are indicated in cases of recurrent posterior instability after the failure of conservative treatment or soft tissue techniques, as well as symptomatic demonstrable nonintentional instability, presence of a posterior glenoid defect >10%, increased glenoid retroversion between 10 and 25°, and posterior rim dysplasia. Bone block fixation techniques that avoid screws and metal allow for satisfactory initial clinical results in a safe and reproducible way. An algorithm for the approach and treatment of recurrent posterior glenohumeral instability is presented, as well as the author's preferred surgical technique for arthroscopic posterior bone block.
复发性肩肱关节后脱位是一种需要高度临床怀疑并进行详细研究以采取正确治疗方法的疾病。其分类必须考虑其生物力学，无论是由于功能性肌肉失衡还是结构改变、意志和意向性。由于其临床表现多样且结构改变各异，从关节囊-盂唇损伤和骨缺损到肩胛盂发育不良和后倾，历史上可用的不同治疗方法失败率都很高。必须进行详细的影像学评估，包括CT和MRI，精确评估肩胛盂和肱骨的骨缺损以及肩胛盂形态。以肩胛周围肌肉再教育和外旋肌强化为重点的物理治疗始终是一线治疗方法。当保守治疗失败时，手术治疗必须根据存在的结构损伤来指导，从软组织修复到后骨块技术，以恢复或增加关节面。在保守治疗或软组织技术失败后的复发性后脱位病例中，以及有症状的可证实的非故意性不稳定、肩胛盂后缺损>10%、肩胛盂后倾增加10至25°以及后缘发育不良的情况下，应采用骨块手术。避免使用螺钉和金属的骨块固定技术能够以安全且可重复的方式获得令人满意的初始临床效果。本文介绍了复发性肩肱关节后脱位的治疗方法和算法，以及作者首选的关节镜下后骨块手术技术。
