Landreau Philippe, Catteeuw Antoine, Altayar Ibrahim
Orthocure & Mediclinic, Dubai, United Arab Emirates.
Department of Orthopaedic Surgery, AZ Monica Hospital, Antwerp, Belgium.
Ann Jt. 2024 May 20;9:26. doi: 10.21037/aoj-23-8. eCollection 2024.
The stability of the glenohumeral joint, known for its remarkable mobility, relies on several factors, including the congruency of the joint's bones and the integrity of capsulolabral structures, encompassing the labrum, the capsule, and the glenohumeral ligaments. In cases of anterior shoulder instability, bone lesions are a common occurrence, most frequently involving glenoid bone loss and Hill-Sachs lesions. When both glenoid and humeral bone lesions coexist, the isolated Bankart procedure has exhibited a significant rate of failure. In such instances, the Latarjet procedure, especially when bone loss is present, retains its position as the gold standard, thanks to its consistent success in both short- and long-term outcomes. Recent advancements in research have explored alternative strategies to address bone loss, including the Remplissage procedure for humeral bone deficits and the use of bone block grafts to manage glenoid bone lesions, with a focus on achieving more anatomical techniques. However, it's crucial to recognize that, beyond bone loss, a multitude of intrinsic and extrinsic factors come into play when determining the most suitable treatment. The patient's profile, including factors like constitutional laxity and activity level, must be carefully considered in the decision-making process. The Latarjet procedure maintains its esteemed status as a benchmark in the field, thanks to its consistent excellence in both short- and long-term results. This article seeks to provide insights into the roles and placement of various surgical techniques within the context of chronic anterior shoulder instability, taking into account the intricate interplay of factors that influence treatment decisions.
以其卓越的活动度而闻名的盂肱关节的稳定性依赖于多种因素，包括关节骨骼的一致性以及关节囊唇结构的完整性，其中包括盂唇、关节囊和盂肱韧带。在前肩不稳的病例中，骨损伤很常见，最常涉及肩胛盂骨丢失和希尔-萨克斯损伤。当肩胛盂和肱骨骨损伤同时存在时，单纯的Bankart手术失败率很高。在这种情况下，Latarjet手术，尤其是在存在骨丢失的情况下，由于其在短期和长期结果方面都取得了持续成功，仍然是金标准。最近的研究进展探索了应对骨丢失的替代策略，包括针对肱骨骨缺损的Remplissage手术以及使用骨块移植来处理肩胛盂骨损伤，重点是实现更符合解剖学的技术。然而，至关重要的是要认识到，除了骨丢失之外，在确定最合适的治疗方法时，还有许多内在和外在因素在起作用。在决策过程中，必须仔细考虑患者的情况，包括体质松弛和活动水平等因素。由于其在短期和长期结果方面始终表现出色，Latarjet手术在该领域仍保持着崇高的地位。本文旨在深入探讨各种手术技术在慢性前肩不稳背景下的作用和应用，同时考虑到影响治疗决策的各种因素之间的复杂相互作用。
