Bonnevialle Nicolas, Massin Valentin, Girard Mathieu, Dalmas Yoann
Département d'Orthopédie Traumatologie, Hôpital Riquet, Centre Hospitalier Universitaire (CHU) de Toulouse, Toulouse, France.
Institut de Recherche Riquet (I2R), Toulouse, France.
Video J Sports Med. 2022 Mar 15;2(2):26350254211038337. doi: 10.1177/26350254211038337. eCollection 2022 Mar-Apr.
The Latarjet procedure is a common treatment of anterior shoulder instability associated with glenoid bone loss. Advanced arthroscopic technique provided a safe cortical-button fixation of the coracoid process transferred onto the glenoid neck combined with a Bankart repair.
This is an 18-year old woman, complaining of recurrent right shoulder dislocation and subluxation, which made her unable to play handball at competitive level. Physical examination confirmed anterior apprehension without hyperlaxity. Computed tomography (CT) scan identified a Hill-Sachs lesion and a glenoid bone loss of 11%. Instability Severity Index Score was calculated at 7 points.
Patient was placed in a beach-chair position under general anesthesia combined with an interscalene nerve block. A 70° scope and specifically designed instruments were used. The technique required 5 steps: (1) coracoid preparation: pectoralis minor and coracoacromial ligament release, flattening of the undersurface, positioning of the peg button, and osteotomy of the coracoid; (2) glenoid preparation: flattening of the neck of the scapula, insertion of 2 anchors (3 and 6 o'clock), and glenoid drilling with a specific guide; (3) subscapularis split: use of an intra-articular and extra-articular spreader splitting the subscapularis muscle at the level of the glenoid wire (shoulder in neutral rotation) and opening of a "safe window"; (4) fixation step: transfer of the coracoid through the subscapularis split with shuttle suture and permanent fixation with a posterior cortical button (compression controlled at 100 Newtons with a dynamometer); and (5) Bankart repair. The shoulder was protected in a sling 4 weeks, and external rotation recovery was allowed at 6 weeks.
Favorable outcomes were reported at 6 months of follow-up without any complication. Full range of motion with limited external rotation deficit was obtained and a negative apprehension test. Radiologic assessment confirmed graft incorporation at 6 months, allowing return to overhead sports at a competitive level.
DISCUSSION/CONCLUSION: Arthroscopic cortical-button Latarjet procedure is a safe option to treat anterior shoulder instability associated with glenoid bone loss in patient with high demand sports. The procedure is safe and combine bone graft and Bankart repair. Using a cortical button fixation avoids screw related complications.
拉塔热手术是治疗与肩胛盂骨质流失相关的肩关节前向不稳的常用方法。先进的关节镜技术可实现将喙突转移至肩胛盂颈部并结合Bankart修复术的安全皮质纽扣固定。
这是一名18岁女性，主诉右肩反复脱位和半脱位，这使她无法在竞技水平上打手球。体格检查证实有前向恐惧试验阳性但无关节过度松弛。计算机断层扫描（CT）显示有Hill-Sachs损伤，肩胛盂骨质流失11%。不稳定严重程度指数评分为7分。
患者在全身麻醉联合肌间沟神经阻滞下取沙滩椅位。使用70°关节镜和专门设计的器械。该技术需要5个步骤：（1）喙突准备：松解胸小肌和喙肩韧带，平整其下表面，放置栓钉纽扣，以及喙突截骨；（2）肩胛盂准备：平整肩胛骨颈部，在3点和6点位置插入2枚锚钉，并使用特定导向器进行肩胛盂钻孔；（3）肩胛下肌劈开：使用关节内和关节外撑开器在肩胛盂钢丝水平劈开肩胛下肌（肩关节中立旋转位）并打开一个“安全窗口”；（4）固定步骤：通过肩胛下肌劈开处用穿梭缝线转移喙突并用后皮质纽扣进行永久固定（用测力计控制压缩力为100牛顿）；以及（5）Bankart修复。肩部用吊带保护4周，6周时允许进行外旋恢复训练。
随访6个月时报告结果良好，无任何并发症。获得了全范围活动，外旋受限不明显，恐惧试验阴性。影像学评估证实6个月时移植物融合，允许患者恢复到竞技水平的过头运动。
讨论/结论：关节镜下皮质纽扣拉塔热手术是治疗有高需求运动的患者中与肩胛盂骨质流失相关的肩关节前向不稳的安全选择。该手术安全，结合了骨移植和Bankart修复。使用皮质纽扣固定可避免螺钉相关并发症。
