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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >The Latarjet Procedure for Anterior Shoulder Instability in Pediatric and Adolescent Athletes
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The Latarjet Procedure for Anterior Shoulder Instability in Pediatric and Adolescent Athletes

机译：Latarjet程序用于小儿和青少年运动员的前肩不稳

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Objectives: To investigate surgical outcomes of the Latarjet procedure in the pediatric and adolescent athletic population compared to alternative techniques used to treat anterior shoulder instability with glenoid bone loss. Methods: This retrospective comparative cohort study involved a review of 40 patient records with a mean age of 16.7 years (range: 14.3 to 19.2) with anterior shoulder instability and glenoid bone loss (mean: 19%). Demographic and clinical features were recorded pre- and post-operatively, with mean follow up of 26.3 months (sd, 22.8). Advanced imaging and arthroscopic assessment were used to quantify concomitant pathology. Percent glenoid bone loss was calculated using the “glenoid rim distances” method. Glenoid track width and Hill-Sachs interval (HSI) were measured to determine if shoulders were on-track or off-track. Patients were contacted to obtain validated functional outcome questionnaires, including Quick-DASH, ASES, and Marx shoulder activity scale. Results: Of the 40 patients, 18 underwent the Latarjet procedure and 22 underwent alternative stabilization procedures. At presentation, both groups were statistically similar with regard to presence of HS (overall 92%), and mechanism of initial dislocation. However, patients who underwent the Latarjet procedure were slightly older at surgery (p=0.045), had longer symptom duration (p=0.015), and had failed more arthroscopic Bankart repair procedures (p=0.002). Additionally, more patients had “off-track” glenohumeral bone loss in the Latarjet group (38%) compared to the control group (9%), (p=0.049). Post-operatively, the Latarjet and control groups had comparable minimal loss of external rotation (47% vs .45%, p=0.768) and high rates of return to sports (94% vs 100%) at a similar time (5.3 vs. 5.4 months, p=1.0). There was a 17% recurrent instability rate in the Latarjet cohort similar to 23% in the control cohort (p=0.709). There were no cases of post-operative nerve palsy or coracoid non-union in those who underwent the Latarjet, compared to one non-union following bony Bankart ORIF in the control group. Functional outcome scores were similarly high across both groups (Table 1). Conclusion: Despite being a technically challenging, salvage-type, open reconstructive shoulder procedure, the Latarjet procedure yielded low complication rates and comparably good outcomes in an adolescent cohort with more risk factors for recurrence than a control group of adolescents undergoing other procedures. For young, athletic patients with multiple instability recurrences, previous surgeries, long symptom duration, and glenohumeral bone loss—including severe, ‘off track’ variations—the Latarjet procedure provides a high rate of return to sports, good/excellent functional outcome scores, and low rates of recurrent instability and complications.
机译：目的：比较与治疗前肩关节不稳伴关节盂骨丢失的替代技术相比，在儿童和青少年运动人群中研究Latarjet手术的手术效果。方法：这项回顾性比较队列研究回顾了40例平均年龄为16.7岁（范围：14.3至19.2），肩关节前不稳定和关节盂骨丢失（平均：19％）的患者记录。术前和术后记录人口和临床特征，平均随访26.3个月（标准误，22.8个月）。先进的成像和关节镜评估被用来量化伴随的病理。使用“关节盂边缘距离”方法计算关节盂骨丢失的百分比。测量Glenoid轨道宽度和Hill-Sachs间隔（HSI），以确定肩膀是在轨道上还是在轨道外。与患者联系以获得有效的功能结局问卷，包括Quick-DASH，ASES和马克思肩膀活动量表。结果：40例患者中，有18例接受了Latarjet手术，22例接受了替代性稳定手术。在介绍时，两组在HS的存在（总体92％）和初始脱位机制方面在统计学上相似。但是，接受Latarjet手术的患者在手术时年龄稍大（p = 0.045），症状持续时间较长（p = 0.015），并且在关节镜下Bankart修复手术失败（p = 0.002）。此外，与对照组（9％）相比，Latarjet组（38％）的患者出现了“脱轨”的盂肱骨骨丢失（p = 0.049）。术后，Latarjet组和对照组的外旋损失极小（47％vs.45％，p = 0.768），并且在相同的时间（5.3 vs. 45）有较高的运动恢复率（94％vs 100％）。 5.4个月，p = 1.0）。 Latarjet队列的复发不稳定性率为17％，而对照队列为23％（p = 0.709）。与对照组相比，接受Latarjet的患者中没有术后神经麻痹或喙突不愈合的病例，而骨性Bankart ORIF术后有1个不愈合的病例。两组的功能结局评分同样较高（表1）。结论：尽管在技术上具有挑战性，采用挽救型开放性肩关节重建术，但Latarjet手术的并发症发生率较低，并且与接受其他手术的对照组相比，其复发风险因素更高。对于具有多次不稳定复发，以前的手术，较长的症状持续时间和盂肱骨丢失（包括严重的“偏离轨道”变化）的年轻运动患者，Latarjet程序可提供较高的运动回报率，良好/出色的功能结局评分，复发不稳定和并发症的发生率低。

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