Olsen Kipp Josephine, Thillemann Theis Muncholm, Petersen Emil Toft, de Raedt Sepp, Borgen Lærke, Brüel Annemarie, Falstie-Jensen Thomas, Stilling Maiken
AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
J Orthop Res. 2025 Mar;43(3):492-504. doi: 10.1002/jor.26028. Epub 2024 Dec 24.
Anterior shoulder instability with glenoid bone lesion can be treated with the Eden-Hybinette procedure utilizing a tricortical iliac crest bone graft or the Latarjet procedure. This study aimed to evaluate the glenohumeral joint (GHJ) kinematics throughout an external shoulder rotation following the Eden-Hybinette and Latarjet procedures. Nine human specimens were examined with dynamic radiostereometry during a GHJ external rotation with anteriorly directed loads from 0 to 30 N. In 30- and 60-degree GHJ abduction, the kinematics (measured as the humeral head center and contact point) was sequentially recorded for a 15% anterior glenoid bone lesion, the Eden-Hybinette, and the Latarjet procedure. The Latarjet and Eden-Hybinette procedures resulted in up to 9.7 mm (95%CI 0.5; 18.8) more posterior and a 7.4 mm (95%CI 0.3; 14.4) superior humeral head center location compared to the glenoid bone lesion. With 0-20 N anterior directed loads, the Latarjet procedure resulted in a more posterior humeral head center and contact point of up to 7.6 mm (95%CI 3.6; 11.5), especially in 60 degrees of GHJ abduction, compared to the Eden-Hybinette procedure. Opposite, at 30 N anterior-directed load, the Eden-Hybinette procedure resulted in a more posterior humeral head center of up to 7.6 mm (95%CI 0.3; 14.9) in 30 degrees GHJ abduction compared to the Latarjet procedure. The results support considering the Latarjet procedures in patients who need the stabilizing effect with the arm in the abducted and externally rotated position (e.g., throwers) and the Eden-Hybinette procedure in patients exposed to high anterior-directed loads with the arm at lower abduction angles (e.g., epilepsia).
伴有肩胛盂骨损伤的前肩不稳可采用使用三皮质髂嵴骨移植的伊登-海比内特手术或拉塔热手术进行治疗。本研究旨在评估伊登-海比内特手术和拉塔热手术后整个肩关节外旋过程中的盂肱关节(GHJ)运动学。在9个尸体标本上,在0至30 N向前负荷下进行GHJ外旋时,采用动态放射立体测量法进行检查。在GHJ外展30度和60度时,依次记录15%肩胛盂骨损伤、伊登-海比内特手术和拉塔热手术后的运动学(以肱骨头中心和接触点衡量)。与肩胛盂骨损伤相比,拉塔热手术和伊登-海比内特手术使肱骨头中心位置向后最多偏移9.7 mm(95%CI 0.5;18.8),向上最多偏移7.4 mm(9%CI 0.3;14.4)。在0至20 N向前负荷下,与伊登-海比内特手术相比,拉塔热手术使肱骨头中心和接触点向后最多偏移7.6 mm(95%CI 3.6;11.5),尤其是在GHJ外展60度时。相反,在30 N向前负荷下,在GHJ外展30度时,与拉塔热手术相比,伊登-海比内特手术使肱骨头中心向后最多偏移7.6 mm(95%CI 0.3;14.9)。结果支持对于需要在手臂外展和外旋位获得稳定效果的患者(如投掷运动员)考虑采用拉塔热手术,而对于手臂处于较低外展角度且承受高向前负荷的患者(如癫痫患者)考虑采用伊登-海比内特手术。