Testa Edward J, Byrne Rory, Petit Logan, Owens Brett D
Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI, USA.
Ann Jt. 2023 Jul 10;8:29. doi: 10.21037/aoj-23-25. eCollection 2023.
Posterior glenohumeral instability is an increasingly common and challenging orthopaedic problem. While an arthroscopic soft tissue stabilization procedure (i.e., reverse Bankart repair) is effective in treating most cases of posterior instability, this procedure may be inadequate in shoulders with critical posterior glenoid bone loss (GBL), or in cases of an engaging reverse Hill-Sachs lesion. Thus, the purpose of the present manuscript was to report contemporary surgical approaches, techniques, and outcomes for the open treatment of glenoid or humeral head bone loss in posterior instability to help guide clinical decision making. Open osteoarticular augmentation procedures have emerged as a popular option to treat posterior bone loss, with bony auto- and allografts utilized from a variety of donor sites including iliac crest, scapular spine, acromion, distal clavicle, and distal tibia. The combination of glenoid retroversion and bone loss can be addressed with a posterior glenoid opening wedge osteotomy. Bipolar bone loss may be treated with a combination of the aforementioned techniques, in addition to a reverse remplissage, a modified McLaughlin procedure, or various arthroplasty-related options. Although short and mid-term outcomes are dependable, studies reporting long-term outcomes are sparse. Moreover, there is no current consensus regarding the most effective treatment of posterior shoulder instability in the setting of bone loss, and open surgical techniques continue to evolve. Further research is necessary to determine long-term effectiveness of these surgical options.
肩关节后向不稳是一种日益常见且具有挑战性的骨科问题。虽然关节镜下软组织稳定手术（即反向Bankart修复）在治疗大多数后向不稳病例中有效，但该手术在存在严重肩胛盂骨丢失（GBL）的肩部或存在嵌顿性反向Hill-Sachs损伤的病例中可能并不充分。因此，本手稿的目的是报告用于开放性治疗后向不稳中肩胛盂或肱骨头骨丢失的当代手术方法、技术及结果，以帮助指导临床决策。开放性骨-关节增强手术已成为治疗后向骨丢失的一种常用选择，使用来自包括髂嵴、肩胛冈、肩峰、锁骨远端和胫骨远端等多种供区的自体骨和异体骨。肩胛盂后倾和骨丢失的组合情况可通过肩胛盂后开角截骨术来解决。双极骨丢失除了可采用反向充填、改良McLaughlin手术或各种关节成形术相关的选择外，还可采用上述技术的组合来治疗。虽然短期和中期结果可靠，但报告长期结果的研究较少。此外，对于骨丢失情况下后肩不稳的最有效治疗方法目前尚无共识，并且开放性手术技术仍在不断发展。有必要进行进一步研究以确定这些手术选择的长期有效性。
