Johnson Emma E, Campbell Michael, Cohen Steven B
Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA.
Video J Sports Med. 2022 Aug 30;2(4):26350254221102460. doi: 10.1177/26350254221102460. eCollection 2022 Jul-Aug.
Locked posterior glenohumeral dislocations are a rare but often missed injury when it occurs. In these dislocations, patients may have a reverse Hill-Sachs lesion, which are associated with high rates of recurrent posterior glenohumeral instability. Open reduction with allograft reconstruction to reconstruct the defect can be used to treat chronic locked posterior glenohumeral dislocations.
Osteochondral allograft reconstruction is indicated when patients have a large defect affecting less than 50% of the articular surface and if the humeral head has been dislocated for less than 6 months.
With the patient in beach chair position, exposure is obtained through deltopectoral approach. An open reduction is performed, and the defect is debrided down to healthy bleeding bone. The defect is templated, and the allograft is harvested and prepared. The allograft is securely fixed using cannulated cancellous screws. The patient undergoes a postoperative rehabilitation protocol.
There have been several case series following allograft reconstruction for locked posterior dislocations that have demonstrated good results. Riff et al found favorable results in his series of 20 patients with isolated humeral head lesions, with significant improvement in patient-outcome measures. There are several potential complications though. A systematic review by Saltzman et al found allograft resorption to occur in 36% and glenohumeral arthritic changes to occur in 35% with frozen allografts. These rates appear to be improved with fresh allografts.
DISCUSSION/CONCLUSION: In conclusion, osteochondral allograft is an effective surgical treatment for large Hill-Sachs defects in chronic locked posterior dislocations.
锁定性肩肱关节后脱位较为罕见，但一旦发生往往容易漏诊。在这些脱位中，患者可能存在反Hill-Sachs损伤，这与肩肱关节后向复发性不稳定的高发生率相关。采用同种异体骨移植重建来修复缺损的切开复位可用于治疗慢性锁定性肩肱关节后脱位。
当患者存在影响关节面不足50%的大缺损且肱骨头脱位时间少于6个月时，适合进行骨软骨同种异体骨移植重建。
患者取沙滩椅位，经三角肌胸大肌入路进行显露。进行切开复位，将缺损清创至健康的出血骨质。对缺损进行模板测量，然后获取并准备同种异体骨。使用空心松质骨螺钉将同种异体骨牢固固定。患者术后接受康复方案。
有多个关于同种异体骨移植重建治疗锁定性后脱位的病例系列显示出良好效果。里夫等人在其20例孤立性肱骨头损伤患者的系列研究中发现了良好结果，患者结局指标有显著改善。不过，也存在一些潜在并发症。萨尔茨曼等人的一项系统评价发现，使用冷冻同种异体骨时，同种异体骨吸收发生率为36%，肩肱关节出现关节炎改变的发生率为35%。使用新鲜同种异体骨时，这些发生率似乎有所改善。
讨论/结论：总之，骨软骨同种异体骨移植是治疗慢性锁定性后脱位中大的Hill-Sachs缺损的一种有效手术方法。
