Pedicled-lesser tuberosity osteotomy for glenohumeral joint exposure: a technical note and case report highlighting its use in allograft reconstruction of a large engaging reverse Hill-Sachs lesion after posterior shoulder dislocation.

带蒂 - 小结节截骨术用于肱骨关节暴露 ： 技术说明和病例报告 ， 强调了其在后肩关节脱位后大型反向 Hill - Sachs 病变的同种异体移植重建中的应用。

• 发表时间: 2021 Aug
• 来源期刊: JSES Rev Rep Tech
• DOI: 10.1016/j.xrrt.2021.04.010
• PMID: 37588950
• 文章类型: Case Reports
• 作者列表: Ker AM,Veen EJD,Maharaj JC,Launay MM,Cutbush K,Gupta A

关键词: Lesser tuberosity osteotomy; allograft; humeral head exposure; reverse Hill-Sachs lesion; shoulder instability; subscapularis

Abstract

Exposure of the humeral articular surface through an anterior approach to the shoulder for grafting humeral bone defects requires partial or complete detachment of the subscapularis tendon and traditionally is achieved through a subscapularis tenotomy, peel tuberosity osteotomy, or lesser tuberosity osteotomy. This case report presents a technique of performing a pedicled-lesser tuberosity osteotomy to allow adequate access for allograft reconstruction of a large reverse Hill-Sachs lesion after a traumatic posterior dislocation, to restore humeral head sphericity and prevent recurrent glenohumeral joint instability. The inferior subscapularis insertion is left intact leaving a periosteal sleeve and preserving the blood supply to the lesser tuberosity and humeral head, with the aim of improving healing of the osteotomy and preventing graft-related complications, such as resorption. Successful union of the pedicled-lesser tuberosity osteotomy and allograft was seen on a 6-month follow-upcomputed tomography scan, with adequate restoration of subscapularis function.

摘要

通过肩关节前入路暴露肱骨关节面以移植肱骨骨缺损需要肩胛骨下肌腱部分或完全脱离，传统上是通过肩胛骨下肌腱切开术实现的，剥离结节截骨术，或小结节截骨术.该病例报告介绍了一种技术，该技术可进行带蒂小结节截骨术，以允许在创伤性后脱位后进行大型反向Hill-Sachs病变的同种异体移植重建。恢复肱骨头球形度，防止盂肱关节反复失稳。下肩胛骨下插入保持完整，留下骨膜套管并保留小结节和肱骨头的血液供应。目的是改善截骨术的愈合和预防移植物相关并发症，如吸收。在6个月的随访计算机断层扫描中，看到了带蒂小结节截骨术和同种异体移植物的成功结合。充分恢复肩胛骨下功能。