Bige Bastien, Recanatesi Nicolas, Gonzalez Jean Francois, Gauci Marc-Olivier
IULS, Hôpital Pasteur, Nice, France.
JSES Int. 2025 Apr 16;9(4):1048-1054. doi: 10.1016/j.jseint.2025.03.014. eCollection 2025 Jul.
We aim to analyze recurrence of dislocation after Latarjet bone block with or without Hill-Sachs Remplissage (HSR) to specify the indication of a combined procedure.
We analyzed 118 patients with a bipolar lesions and a minimum follow-up of 2 years. All procedures were performed arthroscopically by 3 surgeons in on center. Preoperative and postoperative computed tomography (CT) scans were collected. We also collected preoperative and postoperative clinical scores Two groups were identified: 30 patients with arthroscopic Latarjet bone block combined with a HSR (group I) and 88 patients with an isolated Latarjet (group II). Measurements were performed on a reformatted shoulder CT-scan. On preoperative CT-scans, we measured the glenoid bone loss, the width and the length of the humeral lesion then the glenoid track and Hill-Sachs interval.
The mean follow-up is 6 years. Five dislocations occurred in group II, none in group I. The area of glenoid bone loss was higher in group I than in group II (33.4% ± 4.5% vs. 20.5% ± 8.9%, = .001). Twenty shoulders presented an Off-Track lesion preoperatively that was always compensated postoperatively by the bone block in group I. No cutoff was found to be discriminating enough to help in the decision-making process. All recurrences had an Instability Severity Index score > 6.
No recurrence occurred in Group I. However, 5 patients (6%) in Group II experienced a recurrent dislocation with no significant difference. Glenoid track is not an isolated argument to indicate an isolated bone block procedure or a combined HSR. The risk of recurrence increases in patients with an Instability Severity Index score over 6 and in this case, a combine procedure should be recommended.
我们旨在分析采用或不采用希尔-萨克斯充填术（HSR）的拉塔热特骨块术治疗后脱位的复发情况，以明确联合手术的适应证。
我们分析了118例双极损伤患者，最短随访时间为2年。所有手术均由中心的3名外科医生在关节镜下完成。收集术前和术后的计算机断层扫描（CT）图像。我们还收集了术前和术后的临床评分。确定了两组：30例接受关节镜下拉塔热特骨块术联合HSR的患者（I组）和88例单纯接受拉塔热特骨块术的患者（II组）。在重新格式化的肩部CT图像上进行测量。在术前CT图像上，我们测量了肩胛盂骨缺损、肱骨损伤的宽度和长度，然后测量了肩胛盂轨迹和希尔-萨克斯间隙。
平均随访时间为6年。II组发生5例脱位，I组无脱位发生。I组肩胛盂骨缺损面积高于II组（33.4%±4.5%对20.5%±8.9%，P = 0.001）。20例肩部术前存在脱轨损伤，I组术后均通过骨块得到代偿。未发现足以帮助决策过程的鉴别临界值。所有复发性脱位的不稳定严重程度指数评分均>6。
I组未发生复发。然而，II组有5例患者（6%）出现复发性脱位，差异无统计学意义。肩胛盂轨迹不是表明单纯骨块手术或联合HSR手术的唯一依据。不稳定严重程度指数评分超过6的患者复发风险增加，在这种情况下，应建议采用联合手术。
