改良线袢法Latarjet技术治疗肩关节复发性脱位的中期疗效及移植骨块塑形模式分析
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摘要
目的线袢法固定Latarjet手术效果好,但无中长期疗效的报道。该研究首次报道线袢法Latarjet术后中期效果。方法回顾改良线袢法Latarjet手术患者152例,术后随访观察关节活动度、视觉模拟评分(VAS)、Rowe评分、Walch-Duplay评分和美国肩肘外科评分(ASES)。通过X片和CT扫描评估骨块位置、愈合情况及肩关节退变情况。结果术后平均随访(35.3±5.8)个月,所有患者肩关节恢复良好、骨块完全愈合,无复发。术后VAS、Rowe、ASES和Walch-Duplay评分明显改善。术后三维CT扫描En-face位显示,骨块中心平均位于约4点钟位置。146例骨块正常,2例过高,4例骨块过低。术后即刻CT横断面观察,移位骨块与关节盂相平134例,偏外16例,偏内2例。喙突移位骨块出现了不同程度的骨吸收现象,术后平均1年内达到稳定,呈"圆外吸收"现象。全部移植骨块的骨质存在向上、下延伸爬行塑形现象。术后并发症发生率仅为1.3%,全部病例未出现肩关节退变情况。结论线袢固定Latarjet中期疗效好,可有效避免关节盂退变的并发症,移植骨块随访过程中呈"圆外吸收"特点,塑形呈延伸爬行现象,最终关节盂与骨块融合塑形成正梨形关节盂。
Objective The suture button Latarjet technique has been proved for excellent efficacy, however, the mid-term results are lacking. This study is to investigate the efficacy of suture button Latarjet procedure with midterm follow-up. Methods A total of 152 patients who underwent suture button Latarjet operation were enrolled in this study. Range of motion, VAS score, Rowe score, Walch-Duplay and ASES score were followed postoperatively.Meanwhile, the graft position, healing condition of coracoid grafts and the arthropathy of glenoid and humeral head were also assessed according to the X-ray and three-dimensional computed tomograph scans. Results The mean follow-up time duration is(35.3 ± 5.8) months. All the patients recovered well, all grafts healed and no redislocation occurred. The mean visual analog scale score for instability during motion, the ASES score, Rowe Score and WalchDuplay score all improved significantly. Immediate postoperatively, the average graft midline center is at 4 o'clock at the e-face view, 146 cases positioned normally, 2 cases superiorly and 4 cases inferiorly. At the axial view, the CT scans showed 134 cases were flush to the glenoid, 2 cases and 16 cases positioned medially and laterally respectively.The coracoid graft showed different degrees of bone resorption, which reached a stable level within an average of1 year after operation, showing an "out of circle" absorption phenomenon. All bone grafts exhibited upward and downward extension, creeping and shaping. No complication and arthropathy was found. Conclusion The suture button Latarjet technique has achieved an excellent clinical effect and can effectively avoid the complications of joint arthropathy. During the follow-up, the graft showed the characteristics of "out of circle" absorption phenomenonand extended creeping. Finally, the glenoid was fused with the graft to form a pyriform glenoid.
Objective The suture button Latarjet technique has been proved for excellent efficacy, however, the mid-term results are lacking. This study is to investigate the efficacy of suture button Latarjet procedure with midterm follow-up. Methods A total of 152 patients who underwent suture button Latarjet operation were enrolled in this study. Range of motion, VAS score, Rowe score, Walch-Duplay and ASES score were followed postoperatively.Meanwhile, the graft position, healing condition of coracoid grafts and the arthropathy of glenoid and humeral head were also assessed according to the X-ray and three-dimensional computed tomograph scans. Results The mean follow-up time duration is(35.3 ± 5.8) months. All the patients recovered well, all grafts healed and no redislocation occurred. The mean visual analog scale score for instability during motion, the ASES score, Rowe Score and WalchDuplay score all improved significantly. Immediate postoperatively, the average graft midline center is at 4 o'clock at the e-face view, 146 cases positioned normally, 2 cases superiorly and 4 cases inferiorly. At the axial view, the CT scans showed 134 cases were flush to the glenoid, 2 cases and 16 cases positioned medially and laterally respectively.The coracoid graft showed different degrees of bone resorption, which reached a stable level within an average of1 year after operation, showing an "out of circle" absorption phenomenon. All bone grafts exhibited upward and downward extension, creeping and shaping. No complication and arthropathy was found. Conclusion The suture button Latarjet technique has achieved an excellent clinical effect and can effectively avoid the complications of joint arthropathy. During the follow-up, the graft showed the characteristics of "out of circle" absorption phenomenonand extended creeping. Finally, the glenoid was fused with the graft to form a pyriform glenoid.
引文
[1]MARION B, KLOUCHE S, DERANLOT J, et al. A prospective comparativestudyofarthroscopicversusmini-openLatarjet procedure with a minimum 2-year follow-up[J]. Arthroscopy, 2017,33(2):269-277.
[2]ZHU Y M, JIANG C, SONG G, et al. Arthroscopic Latarjet procedure with anterior capsular reconstruction:clinical outcome and radiologic evaluation with a minimum 2-year follow-up[J].Arthroscopy, 2017, 33(12):2128-2135.
[3]KORDASIEWICZ B, MALACHOWSKI K, KICINSKI M, et al.Comparative study of open and arthroscopic coracoid transfer for shoulder anterior instability(Latarjet)-clinical results at short term follow-up[J]. Int Orthop, 2017, 41(5):1023-1033.
[4]CUNNINGHAMG,BENCHOUKS,KHERADO,etal.Comparison of arthroscopic and open Latarjet with a learning curveanalysis[J].KneeSurgSports Traumatol Arthrosc,2016,24(2):540-545.
[5]MAKHNI E C, LAMBA N, SWART E, et al. Revision arthroscopic repair versus Latarjet procedure in patients with recurrent instability after initial repair attempt:a cost-effectiveness model[J].Arthroscopy, 2016, 32(9):1764-1770.
[6]HOBBY J, GRIFFIN D, DUNBAR M, et al. Is arthroscopic surgery for stabilisation of chronic shoulder instability as effective as open surgery? A systematic review and meta-analysis of 62 studies including 3044 arthroscopic operations[J]. J Bone Joint Surg Br,2007, 89(9):1188-1196.
[7]NOURISSAT G, NEYTON L, METAIS P, et al. Functional outcomes after open versus arthroscopic Latarjet procedure:a prospectivecomparativestudy[J].Orthop TraumatolSurgRes,2016, 102(8S):S277-S279.
[8]LONGO U G, LOPPINI M, RIZZELLO G, et al. Latarjet, Bristow,and Eden-Hybinette procedures for anterior shoulder dislocation:systematic review and quantitative synthesis of the literature[J].Arthroscopy, 2014, 30(9):1184-1211.
[9]YANG J S, MAZZOCCA A D, COTE M P, et al. Recurrent anterior shoulder instability with combined bone loss:treatment and results with the modified latarjet procedure[J]. Am J Sports Med, 2016,44(4):922-932.
[10]GENDRE P, THéLU C E, D’OLLONNE T, et al. Coracoid bone block fixation with cortical buttons:an alternative to screw fixation[J]. Orthop Traumatol Surg Res, 2016, 102(8):983-987.
[11]SUGAYAH,MORIISHIJ,DOHIM,etal.Glenoidrim morphologyinrecurrentanteriorglenohumeralinstability[J].J Bone Joint Surg Am, 2003, 85(5):878-884.
[12]BOILEAU P, GENDRE P, BABA M, et al. A guided surgical approach and novel fixation method for arthroscopic Latarjet[J].J Shoulder Elbow Surg, 2016, 25(1):78-89.
[13]NOURISSATG,DELAROCHEC,BOUILLETB,etal.Optimization of bone-block positioning in the Bristow-Latarjet procedure:a biomechanical study[J]. Orthop Traumatol Surg Res,2014, 100(5):509-513.
[14]HOVELIUS L K, SANDSTR?M B C, R?SMARK D L, et al. Long-term results with the Bankart and Bristow-Latarjet procedures:recurrent shoulder instability and arthropathy[J].J Shoulder Elbow Surg, 2001, 10(5):445-452.
[15]SAMILSON R L, PRIETO V. Dislocation arthropathy of the shoulder[J]. J Bone Joint Surg Am, 1983, 65(4):456-460.
[16]DE CARLI A, VADALàA, PROIETTI L, et al. Latarjet procedure versusopencapsuloplastyintraumaticanteriorshoulder dislocation:long-term clinical and functional results[J]. Int Orthop, 2019, 43(1):237-242.
[17]LAFOSSE L, BOYLE S, GUTIERREZ-ARAMBERRI M, et al.Arthroscopic Latarjet procedure[J]. Orthop Clin North Am, 2010,41(3):393-405.
[18]NEYTON L, BARTH J, NOURISSAT G, et al. Arthroscopic Latarjet techniques:graft and fixation positioning assessed with2-dimensional computed tomography is not equivalent with standard open technique[J]. Arthroscopy, 2018, 34(7):2032-2040.
[19]BOILEAU P, THéLU Cé, MERCIER N, et al. Arthroscopic Bristow-Latarjet combined with bankart repair restores shoulder stability in patients with glenoid bone loss[J]. Clin Orthop Relat Res, 2014, 472(8):2413-2424.
[20]METAIS P, CLAVERT P, BARTH J, et al. Preliminary clinical outcomesofLatarjet-Pattecoracoidtransferbyarthroscopyvs.open surgery:prospective multicentre study of 390 cases[J].Orthop Traumatol Surg Res, 2016, 102(8S):S271-S276.
[21]BOILEAU P, SALIKEN D. Editorial commentary:The Wake of the Dragon:will the orthopaedic community adopt the shoulder arthroscopicLatarjet procedure as we adopted the arthroscopic rotator cuff repair[J]. Arthroscopy, 2017, 33(12):2139-2143.
[22]DOMOS P, LUNINI E, WALCH G. Contraindications and complications of the Latarjet procedure[J]. Shoulder Elbow, 2018,10(1):15-24.
[23]YOUNG A A, BABA M, NEYTON L, et al. Coracoid graft dimensionsafterharvestingfortheopenLatarjetprocedure[J].J Shoulder Elbow Surg, 2013, 22(4):485-488.
[24]JOSHI M A, YOUNG A A, BALESTRO J C, et al. The LatarjetPatteprocedureforrecurrentanteriorshoulderinstabilityin contact athletes[J]. Orthop Clin North Am, 2015, 46(1):105-111.
[2]ZHU Y M, JIANG C, SONG G, et al. Arthroscopic Latarjet procedure with anterior capsular reconstruction:clinical outcome and radiologic evaluation with a minimum 2-year follow-up[J].Arthroscopy, 2017, 33(12):2128-2135.
[3]KORDASIEWICZ B, MALACHOWSKI K, KICINSKI M, et al.Comparative study of open and arthroscopic coracoid transfer for shoulder anterior instability(Latarjet)-clinical results at short term follow-up[J]. Int Orthop, 2017, 41(5):1023-1033.
[4]CUNNINGHAMG,BENCHOUKS,KHERADO,etal.Comparison of arthroscopic and open Latarjet with a learning curveanalysis[J].KneeSurgSports Traumatol Arthrosc,2016,24(2):540-545.
[5]MAKHNI E C, LAMBA N, SWART E, et al. Revision arthroscopic repair versus Latarjet procedure in patients with recurrent instability after initial repair attempt:a cost-effectiveness model[J].Arthroscopy, 2016, 32(9):1764-1770.
[6]HOBBY J, GRIFFIN D, DUNBAR M, et al. Is arthroscopic surgery for stabilisation of chronic shoulder instability as effective as open surgery? A systematic review and meta-analysis of 62 studies including 3044 arthroscopic operations[J]. J Bone Joint Surg Br,2007, 89(9):1188-1196.
[7]NOURISSAT G, NEYTON L, METAIS P, et al. Functional outcomes after open versus arthroscopic Latarjet procedure:a prospectivecomparativestudy[J].Orthop TraumatolSurgRes,2016, 102(8S):S277-S279.
[8]LONGO U G, LOPPINI M, RIZZELLO G, et al. Latarjet, Bristow,and Eden-Hybinette procedures for anterior shoulder dislocation:systematic review and quantitative synthesis of the literature[J].Arthroscopy, 2014, 30(9):1184-1211.
[9]YANG J S, MAZZOCCA A D, COTE M P, et al. Recurrent anterior shoulder instability with combined bone loss:treatment and results with the modified latarjet procedure[J]. Am J Sports Med, 2016,44(4):922-932.
[10]GENDRE P, THéLU C E, D’OLLONNE T, et al. Coracoid bone block fixation with cortical buttons:an alternative to screw fixation[J]. Orthop Traumatol Surg Res, 2016, 102(8):983-987.
[11]SUGAYAH,MORIISHIJ,DOHIM,etal.Glenoidrim morphologyinrecurrentanteriorglenohumeralinstability[J].J Bone Joint Surg Am, 2003, 85(5):878-884.
[12]BOILEAU P, GENDRE P, BABA M, et al. A guided surgical approach and novel fixation method for arthroscopic Latarjet[J].J Shoulder Elbow Surg, 2016, 25(1):78-89.
[13]NOURISSATG,DELAROCHEC,BOUILLETB,etal.Optimization of bone-block positioning in the Bristow-Latarjet procedure:a biomechanical study[J]. Orthop Traumatol Surg Res,2014, 100(5):509-513.
[14]HOVELIUS L K, SANDSTR?M B C, R?SMARK D L, et al. Long-term results with the Bankart and Bristow-Latarjet procedures:recurrent shoulder instability and arthropathy[J].J Shoulder Elbow Surg, 2001, 10(5):445-452.
[15]SAMILSON R L, PRIETO V. Dislocation arthropathy of the shoulder[J]. J Bone Joint Surg Am, 1983, 65(4):456-460.
[16]DE CARLI A, VADALàA, PROIETTI L, et al. Latarjet procedure versusopencapsuloplastyintraumaticanteriorshoulder dislocation:long-term clinical and functional results[J]. Int Orthop, 2019, 43(1):237-242.
[17]LAFOSSE L, BOYLE S, GUTIERREZ-ARAMBERRI M, et al.Arthroscopic Latarjet procedure[J]. Orthop Clin North Am, 2010,41(3):393-405.
[18]NEYTON L, BARTH J, NOURISSAT G, et al. Arthroscopic Latarjet techniques:graft and fixation positioning assessed with2-dimensional computed tomography is not equivalent with standard open technique[J]. Arthroscopy, 2018, 34(7):2032-2040.
[19]BOILEAU P, THéLU Cé, MERCIER N, et al. Arthroscopic Bristow-Latarjet combined with bankart repair restores shoulder stability in patients with glenoid bone loss[J]. Clin Orthop Relat Res, 2014, 472(8):2413-2424.
[20]METAIS P, CLAVERT P, BARTH J, et al. Preliminary clinical outcomesofLatarjet-Pattecoracoidtransferbyarthroscopyvs.open surgery:prospective multicentre study of 390 cases[J].Orthop Traumatol Surg Res, 2016, 102(8S):S271-S276.
[21]BOILEAU P, SALIKEN D. Editorial commentary:The Wake of the Dragon:will the orthopaedic community adopt the shoulder arthroscopicLatarjet procedure as we adopted the arthroscopic rotator cuff repair[J]. Arthroscopy, 2017, 33(12):2139-2143.
[22]DOMOS P, LUNINI E, WALCH G. Contraindications and complications of the Latarjet procedure[J]. Shoulder Elbow, 2018,10(1):15-24.
[23]YOUNG A A, BABA M, NEYTON L, et al. Coracoid graft dimensionsafterharvestingfortheopenLatarjetprocedure[J].J Shoulder Elbow Surg, 2013, 22(4):485-488.
[24]JOSHI M A, YOUNG A A, BALESTRO J C, et al. The LatarjetPatteprocedureforrecurrentanteriorshoulderinstabilityin contact athletes[J]. Orthop Clin North Am, 2015, 46(1):105-111.