Yu Weilin, Wu Di, Yuan Chenrui, Jiang Xiping, He Yaohua
Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
Arthroscopy. 2025 May;41(5):1326-1334. doi: 10.1016/j.arthro.2024.07.035. Epub 2024 Aug 20.
To evaluate the clinical and radiologic outcomes of the arthroscopic autologous iliac crest grafting (AICG) procedure with an adjustable-loop suspensory fixation device in the treatment of anterior shoulder instability with glenoid bone defects.
A retrospective review was conducted on the patients who underwent arthroscopic AICG with an adjustable-loop suspensory fixation device from January 2017 to December 2020. Patients with traumatic anterior shoulder instability, significant glenoid bone defects, and a minimum follow-up of 24 months were included. Patient-reported outcomes, including the Oxford Shoulder Instability Score (OSIS), the Rowe score, the Walch-Duplay score, the Constant score, and the visual analog scale score, were compared preoperatively and postoperatively. Radiologic assessments using computed tomography were performed before and after the procedure. Additional data on active range of motion, recurrence events, and complications were recorded.
A total of 42 patients were included in the study, with a mean follow-up time of 35.2 months, ranging from 25.1 to 55.9 months. Mean preoperative OSIS, Rowe score, Walch-Duplay score, and Constant score significantly improved from 24.4 ± 7.2, 25.0 ± 9.0, 25.2 ± 9.8, 87.5 ± 7.1 to 42.4 ± 4.9, 92.4 ± 8.1, 87.9 ± 8.3, and 93.6 ± 4.5 at the last follow-up, respectively. All patients exceeded the minimal clinically important difference for OSIS, Rowe, and Walch-Duplay scores. The graft union rate was 100%, and the glenoid area increased significantly from 82.5% preoperatively to 100.1% at the final follow-up. No patient experienced a recurrence of instability. Two recorded complications included one case of dysesthesia around the donor site and one case of postoperative shoulder stiffness.
The outcomes of the arthroscopic AICG procedure, which uses an adjustable-loop suspensory fixation device, demonstrated stable bone graft fixation, high rates of graft integration, favorable clinical results, and a low incidence of complications. Moreover, the remodeling of the graft during the follow-up period significantly restored the width and concavity of the inferior glenoid, contributing to the overall recovery.
Level IV, retrospective case series.
评估采用可调环悬吊固定装置的关节镜下自体髂嵴植骨术（AICG）治疗伴有肩胛盂骨缺损的前肩不稳的临床和影像学结果。
对2017年1月至2020年12月期间接受采用可调环悬吊固定装置的关节镜下AICG的患者进行回顾性研究。纳入创伤性前肩不稳、存在明显肩胛盂骨缺损且随访至少24个月的患者。比较术前和术后患者报告的结果，包括牛津肩不稳评分（OSIS）、Rowe评分、Walch-Duplay评分、Constant评分和视觉模拟量表评分。在手术前后进行计算机断层扫描的影像学评估。记录有关主动活动范围、复发事件和并发症的其他数据。
本研究共纳入42例患者，平均随访时间为35.2个月，范围为25.1至55.9个月。末次随访时，术前平均OSIS、Rowe评分、Walch-Duplay评分和Constant评分分别从24.4±7.2、25.0±9.0、25.2±9.8、87.5±7.1显著改善至42.4±4.9、92.4±8.1、87.9±8.3和93.6±4.5。所有患者的OSIS、Rowe和Walch-Duplay评分均超过最小临床重要差异。植骨愈合率为100%，肩胛盂面积从术前的82.5%显著增加至末次随访时的100.1%。没有患者出现不稳复发。记录的2例并发症包括1例供区周围感觉异常和1例术后肩关节僵硬。
采用可调环悬吊固定装置的关节镜下AICG手术结果显示植骨固定稳定、植骨融合率高、临床效果良好且并发症发生率低。此外，随访期间植骨的重塑显著恢复了肩胛盂下部的宽度和凹陷，有助于整体恢复。
IV级，回顾性病例系列。
