Raiss Patric, Campagnoli Alexander, Bachmaier Samuel, Anderl Matthias, Wittmann Thomas
OCM, Munich, Germany.
Arthrex GmbH, Munich, Germany.
Arthrosc Tech. 2024 Jan 1;13(4):102899. doi: 10.1016/j.eats.2023.102899. eCollection 2024 Apr.
The Latarjet procedure is a proven and effective operation to treat anterior shoulder instability. Especially in cases with anterior glenoid bone loss, the Latarjet operation is the most popular procedure to restore glenoid anatomy and avoid further dislocations. Next to the re-creation of the missing glenoid bone, the sling effect of the conjoint tendon transferred between a split in the subscapularis muscle is an important "soft tissue stabilizer" of the humeral head. However, it has been shown that the inferior part of the subscapularis muscle tends to degenerate, leading to fatty infiltration of the muscle itself. Also, exposure through the subscapularis split is technically demanding, and there is a risk of nerve damage due to the pulling forces of the retractors during open surgery. When performing the procedure arthroscopically, extremely low and medial portals are necessary to find a correct angle for the glenoid drilling when approaching from anterior. Neurovascular structures may be at risk during these surgical steps. The aim of the flipped Latarjet procedure is to facilitate a safe and reliable arthroscopic operation to anteriorly stabilize the shoulder by transferring the coracoid to the deficient glenoid without splitting the subscapularis muscle while keeping the benefits of a sling effect of the conjoined tendon.
拉塔热手术是一种经证实的有效治疗肩关节前不稳定的手术。特别是在存在肩胛盂前部骨质缺损的情况下，拉塔热手术是恢复肩胛盂解剖结构并避免进一步脱位的最常用手术。除了重建缺失的肩胛盂骨质外，联合肌腱在肩胛下肌劈开处转移所产生的吊带效应是肱骨头重要的“软组织稳定器”。然而，研究表明肩胛下肌下部容易发生退变，导致肌肉本身出现脂肪浸润。此外，通过肩胛下肌劈开处进行显露在技术上要求较高，并且在开放手术过程中由于牵开器的拉力存在神经损伤的风险。当进行关节镜手术时，从前侧入路进行肩胛盂钻孔时需要非常低且靠内侧的入路来找到正确的角度。在这些手术步骤中神经血管结构可能会面临风险。翻转拉塔热手术的目的是通过在不劈开肩胛下肌的情况下将喙突转移至肩胛盂缺损处，同时保留联合肌腱吊带效应的益处，从而促进一种安全可靠的关节镜手术来实现肩关节前侧稳定。
