Rosenow Christian S, Leland Devin P, Camp Christopher L, Barlow Jonathan D
Mayo Clinic Department of Orthopedic Surgery, 200 First Street SW, Rochester, 55905, MN, USA.
Curr Rev Musculoskelet Med. 2024 Jun;17(6):207-221. doi: 10.1007/s12178-024-09895-x. Epub 2024 Apr 8.
Anterior shoulder instability is associated with concomitant injury to several stabilizing structures of the shoulder, including glenoid bone loss. While instability is most common in young athletes and patients with predisposing conditions of hyperlaxity, recurrent shoulder instability can occur throughout various age ranges and may lead to longer term effects including pain and shoulder arthritis. Glenoid bone loss exceeding certain thresholds is generally treated by glenoid reconstruction via bone block augmentation to adequately stabilize the glenohumeral joint. These procedures increase the width of the articular surface on which the humeral head can translate before dislocation and, based on the procedure performed, provide a sling effect via the conjoined tendon, and increase tension to support the anterior capsule. The purpose of this review is to summarize the available literature regarding bone block fixation techniques.
Various fixation techniques have been utilized to secure bone block transfers. Though screw fixation has traditionally been used for bone block fixation, suture buttons, suture anchors, and all-suture techniques have been utilized in attempts to avoid complications associated with the use of screws. Biomechanical studies report variable force-resistance, displacement, and mode of failure when comparing screw to suture button-based fixation of glenoid bone blocks. Clinical and radiographic studies have shown these novel suture-based techniques to be comparable, and in some cases advantageous, to traditional screw fixation techniques. While screw fixation has long been the standard of care in glenoid bone block procedures, it is associated with high complication rates, leading surgeons to endeavor toward new fixation techniques. In available biomechanical studies, screw fixation has consistently demonstrated high maximal load-to-failure and displacement with cyclic loading. Studies have reported similar clinical and radiographic outcomes in both screw and suture-based fixation methods, with evidence of reduced bone resorption with suture fixation. While suture button fixation is associated with a higher rate of recurrent instability, overall complication rates are low. Future research should address biomechanical shortcomings of suture-based fixation techniques and continue to assess long-term follow-up of patients treated with each fixation method.
肩关节前不稳定与肩部多个稳定结构的合并损伤有关，包括肩胛盂骨丢失。虽然不稳定在年轻运动员和具有易患关节过度松弛症的患者中最为常见，但复发性肩关节不稳定可发生在各个年龄段，并可能导致包括疼痛和肩关节关节炎在内的长期影响。超过特定阈值的肩胛盂骨丢失通常通过骨块增强进行肩胛盂重建来充分稳定盂肱关节。这些手术增加了肱骨头在脱位前可平移的关节表面宽度，并根据所进行的手术，通过联合肌腱提供吊带效应，并增加张力以支持前关节囊。本综述的目的是总结关于骨块固定技术的现有文献。
已采用各种固定技术来固定骨块移植。虽然传统上使用螺钉固定来进行骨块固定，但也尝试使用缝合纽扣、缝合锚钉和全缝合技术来避免与使用螺钉相关的并发症。生物力学研究报告称，在比较螺钉与基于缝合纽扣的肩胛盂骨块固定时，其抗力、位移和失效模式各不相同。临床和影像学研究表明，这些新型基于缝合的技术与传统螺钉固定技术相当，在某些情况下更具优势。虽然螺钉固定长期以来一直是肩胛盂骨块手术的标准治疗方法，但它与高并发症发生率相关，这促使外科医生寻求新的固定技术。在现有的生物力学研究中，螺钉固定在循环加载下始终表现出较高的最大破坏载荷和位移。研究报告了螺钉和基于缝合的固定方法在临床和影像学结果上相似，有证据表明缝合固定可减少骨吸收。虽然缝合纽扣固定与较高的复发性不稳定发生率相关，但总体并发症发生率较低。未来的研究应解决基于缝合的固定技术的生物力学缺点，并继续评估采用每种固定方法治疗的患者的长期随访情况。
