Keeling Laura E, Wagala Nyaluma, Ryan Patrick M, Gilbert Ryan, Hughes Jonathan D
Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Orthopedic Surgery, Baylor Scott & White Medical Center, Temple, TX, USA.
Ann Jt. 2023 Jul 5;8:27. doi: 10.21037/aoj-23-6. eCollection 2023.
Glenohumeral bone loss is frequently observed in cases of recurrent anterior and posterior shoulder instability and represents a risk factor for failure of nonoperative treatment. Patients with suspected glenoid or humeral bone loss in the setting of recurrent instability should be evaluated with a thorough history and physical examination, as well as advanced imaging including computed tomography (CT) and/or magnetic resonance imaging (MRI). In cases of both anterior and posterior instability, the magnitude and location of bone loss should be determined, as well as the relationship between the glenoid track (GT) and any humeral defects. While the degree and pattern of osseous deficiency help guide treatment, patient-specific risk factors for recurrent instability must also be considered when determining patient management. Treatment options for subcritical anterior bone loss include labral repair and capsular plication, while more severe deficiency should prompt consideration of bony augmentation including coracoid transfer or free bone block procedures. Concomitant humeral lesions are treated according to the degree of engagement with the glenoid rim and may be addressed with soft tissue remplissage or bony augmentation procedures. While critical and subcritical thresholds of glenoid bone loss guide the management of anterior instability, such thresholds are less defined in the setting of posterior instability. Furthermore, current treatment algorithms are limited by a lack of long-term comparative studies. Future high-quality studies as well as possible modifications in indications and surgical technique are required to elucidate the optimal treatment of anterior, posterior, and bipolar glenohumeral bone loss in the setting of recurrent shoulder instability.
复发性肩关节前、后不稳病例中常可见盂肱关节骨质流失，这是非手术治疗失败的一个危险因素。对于复发性不稳情况下疑似存在肩胛盂或肱骨骨质流失的患者，应通过全面的病史和体格检查以及包括计算机断层扫描（CT）和/或磁共振成像（MRI）在内的先进影像学检查进行评估。对于前、后不稳的病例，应确定骨质流失的程度和位置，以及肩胛盂轨迹（GT）与任何肱骨缺损之间的关系。虽然骨缺损的程度和模式有助于指导治疗，但在确定患者的治疗方案时，还必须考虑患者复发性不稳的特定危险因素。临界以下的前侧骨质流失的治疗选择包括盂唇修复和关节囊折叠，而更严重的缺损则应考虑进行骨增强，包括喙突转移或游离骨块手术。合并的肱骨病变根据与肩胛盂边缘的接触程度进行治疗，可采用软组织填充或骨增强手术。虽然肩胛盂骨质流失的临界和临界以下阈值可指导前侧不稳的治疗，但在后侧不稳的情况下，这些阈值的定义尚不明确。此外，目前的治疗算法受到缺乏长期对比研究的限制。需要未来的高质量研究以及适应症和手术技术的可能改进，以阐明复发性肩关节不稳情况下前侧、后侧和双极盂肱关节骨质流失的最佳治疗方法。
