de Campos Azevedo Clara, Ângelo Ana Catarina
Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hospital dos SAMS de Lisboa, Lisbon, Portugal.
Shoulder and Elbow Unit, Orthopaedic and Musculoskeletal Centre, Cuf Tejo Hospital, Lisbon, Portugal.
Arthrosc Sports Med Rehabil. 2023 Feb 23;5(2):e445-e457. doi: 10.1016/j.asmr.2023.01.012. eCollection 2023 Apr.
To report the results of the onlay dynamic anterior stabilization (DAS) using the long head of biceps (LHB) and the double double-pulley technique for the treatment of anterior glenohumeral instability (AGI) with ≤20% glenoid bone loss (GBL).
From September 2018 to December 2021, patients with AGI and ≤20% GBL were enrolled in a prospective study on DAS and followed for a minimum of 1 year. The primary outcomes were Western Ontario Shoulder Instability Index, Rowe score, range of motion, and strength. The secondary outcomes were ability to return to play (RTP), RTP at same level, lack of recurrence of instability, successful LHB healing, and lack of complications. Magnetic resonance imaging was used to measure GBL, Hill-Sachs interval, glenoid track, and assess LHB integrity.
Eighteen consecutive patients underwent DAS. Fifteen patients had a minimum follow-up of 12 months (mean, 23.93 ± 13.67 months). In total, 12 were male and 3 female patients; 73.3% practiced recreational sports; mean age at surgery was 23.40 ± 6.53 years; mean number of dislocation episodes were 10.13 ± 8.42; mean GBL was 8.21 ± 7.39% (range, 0-20.24%); mean Hill-Sachs interval was 15.00 ± 2.96 mm; and mean glenoid track was 18.87 ± 2.57mm. The mean improvement in the Western Ontario Shoulder Instability Index and Rowe score (959.27 ± 386.70 and 74.00 ± 22.22 points) was significant ( < .001 and < .001) and more than 6 times greater than the minimum clinically important difference. The mean improvement in active elevation, abduction, and external and internal rotation (23.00 ± 27.76°, 33.33 ± 43.78°, 8.33 ± 13.58°, and 0.73 ± 1.28 points) was significant ( = .006, = .011, = .032, and = .044). RTP rate was 93.33%. RTP at same level was 60.00%. One patient with hyperlaxity had a redislocation (6.7% recurrence). No complications were reported. Each magnetic resonance imaging scan showed successful LHB healing to the anterior glenoid.
At a minimum of 1-year follow-up, DAS produces significant and clinically important improvements in shoulder function, successful LHB healing, and is safe for the treatment of AGI with ≤20% GBL without severe hyperlaxity.
IV, therapeutic case series.
报告采用肱二头肌长头（LHB）和双滑轮技术进行覆盖式动态前路稳定术（DAS）治疗盂肱关节前向不稳（AGI）且关节盂骨丢失（GBL）≤20%的结果。
2018年9月至2021年12月，将AGI且GBL≤20%的患者纳入DAS的前瞻性研究，并随访至少1年。主要结局指标为西安大略肩不稳指数、Rowe评分、活动范围和力量。次要结局指标为恢复运动（RTP）能力、在原水平恢复运动、不稳无复发、LHB愈合成功以及无并发症。采用磁共振成像测量GBL、Hill-Sachs间隙、关节盂轨迹，并评估LHB的完整性。
连续18例患者接受了DAS。15例患者的最短随访时间为12个月（平均23.93±13.67个月）。其中男性12例，女性3例；73.3%进行休闲运动；手术时的平均年龄为23.40±6.53岁；平均脱位次数为10.13±8.42次；平均GBL为8.21±7.39%（范围0-20.24%）；平均Hill-Sachs间隙为15.00±2.96mm；平均关节盂轨迹为18.87±2.57mm。西安大略肩不稳指数和Rowe评分的平均改善（959.27±386.70和74.00±22.22分）具有显著性（P<0.001和P<0.001），且比最小临床重要差异大6倍以上。主动抬高、外展、外旋和内旋的平均改善（23.00±27.76°、33.33±43.78°、8.33±13.58°和0.73±1.28分）具有显著性（P=0.006、P=0.011、P=0.032和P=0.044）。RTP率为93.33%。在原水平恢复运动的比例为60.00%。1例关节过度松弛患者出现再脱位（复发率6.7%）。未报告并发症。每次磁共振成像扫描均显示LHB成功愈合至关节盂前部。
至少1年的随访结果显示，DAS在肩功能方面产生了显著且具有临床意义的改善，LHB愈合成功，对于治疗GBL≤20%且无严重关节过度松弛的AGI是安全的。
IV级，治疗性病例系列。
