背景:胫骨远端同种异体移植重建肩关节不稳定的关节盂在过去十年中得到了广泛的关注。先前的研究表明,尽管该方法是通过肩胛骨下分裂进行的,但所有报告的患者结局均有显着改善。以前没有研究评估小结节截骨术后的结果,该研究提供了对前盂的出色暴露。我们假设在较小的结节截骨术中重建胫骨远端同种异体关节盂重建肩关节不稳定后,功能结果显着改善,并且没有有害影响。
方法:自2016年至2019年,回顾性分析了通过小结节截骨术进行同种异体胫骨远端关节盂重建的患者。如果患者患有复发性肩关节前不稳定,关节盂骨丢失>20%,并且有偏离轨道病变的证据,则需要对患者进行指示。临床,成像,和手术数据进行了评估。至少2年评估的客观随访数据包括X光片,运动范围,DASH,SANE,VAS,SST,ASES,和恒定的分数。
结果:共12例患者平均随访28个月,平均年龄26岁,平均关节盂骨丢失33%。患者在最终随访时表现出临床结果的显着改善:DASH42.9-8.9(P=.004),SANE32.2-85(P=.00005),VAS4.6-1.1(P=.003),SST7-11.4(P=0.01),ASES50.2-90.5(P=.001),和常数37.6-86.2(P=0.01)。最终随访时的运动范围为向前弯曲至161.4°(135-170°),外旋49.5°(40-65°),和内部旋转到T12-L1(T7-L2)椎体。
结论:本研究证明了小结节截骨术用于胫骨远端同种异体移植重建关节盂的暴露的有效性。肩胛骨下的功能完整性得以维持,患者报告的结果与现有文献相当。
BACKGROUND: Distal tibia allograft reconstruction of the glenoid in shoulder instability has garnered significant attention over the last decade. Prior studies demonstrate significant improvement in all reported patient outcomes albeit the approach is through a subscapularis split. There have not been prior studies evaluating outcomes after lesser tuberosity osteotomy which provides excellent exposure to the anterior glenoid.We hypothesize there is significant improvement in functional outcomes and no deleterious effects after lesser tuberosity osteotomy for distal tibia allograft reconstruction of the glenoid for shoulder instability.
METHODS: A retrospective review was performed from 2016 of 2019 of patients undergoing distal tibia allograft reconstruction of the glenoid through a lesser tuberosity osteotomy. Patients were indicated if they had recurrent anterior shoulder instability with >20% glenoid bone loss and evidence of an off-track lesion. Clinical, imaging, and operative data were evaluated. Objective follow-up data evaluated at minimum 2 years included radiographs, range of motion, DASH, SANE, VAS, SST, ASES, and Constant scores.
RESULTS: A total of 12 patients were available with average follow-up 28 months, average age 26 years old, and average glenoid bone loss of 33%. The patients demonstrated significant improvement in their clinical outcomes at final follow-up: DASH 42.9-8.9 (P = .004), SANE 32.2-85 (P = .00005), VAS 4.6-1.1 (P = .003), SST 7-11.4 (P = .01), ASES 50.2-90.5 (P = .001), and Constant 37.6-86.2 (P = .01). Range of motion at final follow-up was forward flexion to 161.4° (135-170°), external rotation 49.5° (40-65°), and internal rotation to T12-L1 (T7-L2) vertebral body.
CONCLUSIONS: The present study demonstrates the effectiveness of a lesser tuberosity osteotomy in exposure of the glenoid for reconstruction with a distal tibia allograft. The functional integrity of the subscapularis is maintained and the patient-reported outcomes are comparable with current literature.