Shekhbihi Abdelkader, Bauer Stefan, Walch Arnaud, Reichert Winfried, Walch Gilles, Boileau Pascal
Department of Trauma Surgery, Lörrach District Hospital, Baden-Württemberg, Lörrach, Germany.
Ensemble Hospitalier de la Côte, Morges, Switzerland.
EFORT Open Rev. 2024 Sep 2;9(9):923-932. doi: 10.1530/EOR-23-0208.
The Trillat procedure, initially described by Albert Trillat, is historically one of the first techniques for addressing recurrent anterior shoulder instability, incorporating fascinating biomechanical mechanisms. After lowering, medializing, and fixing the coracoid process to the glenoid neck, the subcoracoid space is reduced, the subscapularis lowered, and its line of pull changed, accentuating the function of the subscapularis as a humeral head depressor centering the glenohumeral joint. Furthermore, the conjoint tendon creates a 'seatbelt' effect, preventing anteroinferior humeral head dislocation. Even though contemporary preferences lean towards arthroscopic Bankart repair with optional remplissage, bone augmentation, and the Latarjet procedure, enduring surgical indications remain valid for the Trillat procedure, which offers joint preservation and superior outcomes in two distinct scenarios: (i) older patients with massive irreparable cuff tears and anterior recurrent instability with an intact subscapularis tendon regardless of the extent of glenoid bone loss; (ii) younger patients with instability associated shoulder joint capsule hyperlaxity without concomitant injuries (glenoid bone loss, large Hill-Sachs lesion). Complications associated with the Trillat procedure include recurrent anterior instability, potential overtightening of the coracoid, leading to pain and a significant reduction in range of motion, risk of subcoracoid impingement, and restriction of external rotation by up to 10°, a limitation that is generally well-tolerated. The Trillat procedure may be an effective alternative technique for specific indications and should remain part of the surgical armamentarium for addressing anterior shoulder instability.
特里拉特手术最初由阿尔贝·特里拉特描述，从历史角度来看，是最早用于解决复发性前肩不稳的技术之一，其蕴含着迷人的生物力学机制。在将喙突降低、内移并固定至关节盂颈部后，喙突下间隙减小，肩胛下肌下移，其拉力线改变，增强了肩胛下肌作为肱骨头下压肌使盂肱关节对中的功能。此外，联合腱产生“安全带”效应，防止肱骨头前下方脱位。尽管当代更倾向于采用关节镜下Bankart修复术并可选择进行 remplissage、骨增强和Latarjet手术，但特里拉特手术仍有持久的手术适应证，在两种不同情况下可实现关节保留并取得良好效果：（i）老年患者，存在巨大的不可修复的肩袖撕裂且前侧复发性不稳，肩胛下肌腱完整，无论关节盂骨质流失程度如何；（ii）年轻患者，存在与不稳相关的肩关节囊过度松弛且无合并损伤（关节盂骨质流失、巨大的Hill-Sachs损伤）。与特里拉特手术相关的并发症包括复发性前肩不稳、喙突可能过度收紧导致疼痛和活动范围显著减小、喙突下撞击风险以及外旋受限达10°，这种限制一般耐受性良好。对于特定适应证，特里拉特手术可能是一种有效的替代技术，应继续作为解决前肩不稳的手术手段之一。
