Orthosud Shoulder Sport Unit, Clinique Saint-Jean Sud de France, Montpellier, France.
Orthosud Shoulder Sport Unit, Clinique Saint-Jean Sud de France, Montpellier, France.
J Shoulder Elbow Surg. 2023 Mar;32(3):610-617. doi: 10.1016/j.jse.2022.08.019. Epub 2022 Oct 4.
The arthroscopic Latarjet procedure is a technically challenging technique that provides well-known results. The first series reported fixation with screws. An alternative fixation technique has been proposed, using a button, to improve the reproducibility and to decrease the complications due to screws. The first reports using this fixation technique have yielded comparable rates of fusion. The objective of this study was to assess the fusion rate and bone modifications with this type of fixation.
Two hundred sixteen patients were included in this prospective study. An arthroscopic Latarjet procedure, fixed with 1 button according to the Smith & Nephew technique, was performed by a single surgeon for the treatment of anterior instability. The radiographic protocol consisted of computed tomography scans at 3, 12, and 24 weeks postoperatively. We measured the coronal and sagittal positions of the bone block, distance between the bone block and the glenoid, diameter of the glenoid tunnel, fusion rate, and time to fusion.
The position was deemed flush in 92.6% of cases in the coronal plane and under the equator in 87.5% of cases in the sagittal plane. At last follow-up, we observed 9 cases of nonunion (4%), as well as 18 cases of delayed fusion. The fusion rate was 92% at 3 months and 96% at 6 months. For bone blocks that ultimately healed, the diameter of the glenoid tunnel was <2 mm in 62% of cases at 3 weeks and <1 mm in 90% of cases at 3 months. Conversely, the diameter of this tunnel significantly increased and was >3 mm in all cases of delayed union or nonunion.
The described technique achieved a reliable position of the bone block and a very good fusion rate with a new type of fixation. The time to obtain fusion can be lengthy, occurring between the third and sixth months. The diameter of the glenoid tunnel was the best predictive factor for fusion. Widening of the glenoid tunnel diameter >3 mm during the first 3 weeks was the most predictive factor for delayed union or nonunion of the bone block. This finding is probably explained by a sliding effect of the sutures through this tunnel, comparable to the bungee effect in anterior cruciate ligament repair in the knee.
关节镜下 Latarjet 手术是一种技术要求较高的手术，其疗效确切。最早的研究报道采用螺钉固定。目前已有研究采用纽扣固定来替代螺钉固定，以提高固定的可重复性，减少螺钉相关并发症。纽扣固定的早期研究报道融合率相似。本研究旨在评估该固定方式的融合率和骨改建情况。
前瞻性研究纳入 216 例患者，由同一位外科医生采用 Smith & Nephew 技术的单纽扣行关节镜下 Latarjet 手术治疗复发性肩关节前脱位。影像学随访方案为术后 3、12 和 24 周行 CT 检查。我们测量骨块的冠状和矢状位置、骨块与关节盂之间的距离、关节盂骨隧道的直径、融合率以及融合时间。
冠状面平齐 92.6%，矢状面位于关节盂下 87.5%。末次随访时，9 例（4%）患者出现骨不连，18 例（8.3%）患者出现延迟愈合。术后 3 个月融合率为 92%，6 个月时为 96%。最终愈合的骨块在术后 3 周时，有 62%的骨隧道直径<2mm，3 个月时 90%的骨隧道直径<1mm。相反，延迟愈合或骨不连患者的骨隧道直径均显著增宽，均>3mm。
该技术采用新型固定方式可获得可靠的骨块位置和较高的融合率。融合时间较长，在术后 3~6 个月。关节盂骨隧道直径是预测融合的最佳指标。术后 3 周内骨隧道直径增宽>3mm 是预测骨块延迟愈合或不愈合的最有价值指标。这可能与缝线在骨隧道内滑动有关，类似于膝关节前交叉韧带修复中的“蹦极效应”。
