Mekky Ahmed Farid, Fossati Chiara, Menon Alessandra, Fici Paolo, Randelli Pietro Simone, Aly Tarek
Knee and Shoulder Arthroscopy Unit, Department of Orthopedic Surgery, Tanta University, El-Geish Street, Tanta 31527, Egypt.
U.O.C. 1º Clinica Ortopedica, ASST Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy.
Healthcare (Basel). 2025 Jul 21;13(14):1768. doi: 10.3390/healthcare13141768.
Recurrent anterior shoulder instability is a common problem and may be associated with glenoid bone defects. Surgical procedures, including Latarjet, are the usual treatment for anterior shoulder instability, associated with significant glenoid bone defects. The aim of this study was to evaluate the clinical outcome and glenohumeral arthritis progression in patients with recurrent anterior shoulder instability and significant bone loss treated by a modified Latarjet procedure. From July 2018 to November 2021, a prospective observational case series was carried out on 21 patients with recurrent anterior shoulder instability associated with significant bone defects treated by a modified Latarjet procedure in which the coracoid process was rotated 90° on its longitudinal axis and the subscapularis muscle was horizontally split. Patients with a glenoid defect of more than 21% were included. Post-operatively, the patients were clinically assessed using modified Rowe scoring. Glenohumeral arthritis, graft position, union, and resorption were radiologically evaluated. The mean age at the time of surgery was 28.52 ± 8.0 (range: 19-45) years. The mean number of dislocations was 18.33 ± 8.67 (range: 6-35) times. The mean glenoid defect size was 26.19 ± 4.85 (range: 21-37) % and Hill-Sachs lesions were off-track in 19 cases. The mean follow-up period was 30.67 ± 7.53 (range: 16-40) months. Eighteen patients (85.7%) showed good to excellent results. The mean modified Rowe score was 85.00 ± 18.77 (range: 30-100) points. The mean external rotation loss was 8.09 ± 5.11° (range: 0-20°). No cases of recurrent instability were observed, and there was no progression of glenohumeral arthritis. The modified Latarjet is an effective and reliable surgical option to treat traumatic anterior shoulder instability with significant bone loss. Most of the reported complications associated with this procedure did not affect the functional outcome.
复发性肩关节前脱位是一个常见问题，可能与肩胛盂骨缺损有关。手术治疗，包括Latarjet手术，是治疗伴有明显肩胛盂骨缺损的肩关节前脱位的常用方法。本研究的目的是评估采用改良Latarjet手术治疗复发性肩关节前脱位并伴有明显骨质流失患者的临床疗效及盂肱关节炎的进展情况。2018年7月至2021年11月，对21例采用改良Latarjet手术治疗的复发性肩关节前脱位并伴有明显骨缺损的患者进行了前瞻性观察病例系列研究。改良Latarjet手术是将喙突沿其纵轴旋转90°，并将肩胛下肌水平劈开。纳入肩胛盂缺损超过21%的患者。术后，采用改良Rowe评分对患者进行临床评估。通过影像学评估盂肱关节炎、移植物位置、愈合及吸收情况。手术时的平均年龄为28.52±8.0岁（范围：19 - 45岁）。平均脱位次数为18.33±8.67次（范围：6 - 35次）。平均肩胛盂缺损大小为26.19±4.85%（范围：21 - 37%），19例存在Hill - Sachs损伤脱位。平均随访时间为30.67±7.53个月（范围：16 - 40个月）。18例（85.7%）患者结果为良好至优秀。平均改良Rowe评分为85.00±18.77分（范围：30 - 100分）。平均外旋丧失为8.09±5.11°（范围：0 - 20°）。未观察到复发性不稳定病例，且盂肱关节炎无进展。改良Latarjet手术是治疗伴有明显骨质流失的创伤性肩关节前脱位的一种有效且可靠的手术选择。该手术报道的大多数并发症并未影响功能结果。
