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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Comparison of a Distal Tibial Allograft and Scapular Spinal Autograft for Posterior Shoulder Instability With Glenoid Bone Loss
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Comparison of a Distal Tibial Allograft and Scapular Spinal Autograft for Posterior Shoulder Instability With Glenoid Bone Loss

机译：远端胫骨同种异体移植物和肩胛椎体移植物与关肩骨损失的肩胛骨缺失的比较

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Background: Posterior glenoid bone deficiency can occur with recurrent glenohumeral instability. Glenoid reconstruction with a distal tibial allograft (DTA) has been reported to successfully restore contact pressures that occur during posterior glenohumeral translation. However, there are concerns regarding the risk of allograft resorption, availability, and costs. Extracapsular reconstruction using a scapular spinal autograft (SSA) has been reported as an alternative technique secondary to its anatomic location relative to the posterior shoulder and preferable autograft properties. There are no known prior biomechanical studies evaluating the scapular spine as an effective extracapsular graft choice. Purpose: To compare the efficacy of a DTA and SSA in restoring the stability of a glenoid with a large posterior bone defect compared with the intact native glenoid. Study Design: Controlled laboratory study. Methods: Ten cadaveric shoulders were tested. With the use of a custom KUKA robot, a 50-N compressive force was applied to the glenohumeral joint. The peak force required to translate the humeral head beyond the glenoid lip posteriorly as well as the lateral displacement that occurred during posterior translation were measured. Testing was performed in 5 conditions: (1) intact glenoid and labrum, (2) simulated reverse Bankart lesion, (3) 12-mm posterior glenoid defect, (4) glenoid defect reconstructed with a fresh DTA, and (5) glenoid defect reconstructed with an SSA. Results: The mean glenoid width was 30 mm. The mean peak force and lateral displacement decreased significantly with a glenoid defect (0.99 ± 2.3 N and 0.06 ± 0.09 mm, respectively; P < .0001) compared with the intact glenoid (23.00 ± 9.7 N and 1.83 ± 0.70 mm, respectively; P = .0001). There was no significant difference between the peak force after reconstruction of the defect with a DTA (23.00 ± 7.4 N) and SSA (23.00 ± 7.7 N) when compared with the intact glenoid ( P = .9999). There were no significant differences in the peak force between the 2 grafts ( P = .9999). Additionally, both the DTA (1.04 ± 1.09 mm) and the SSA (1.02 ± 1.17 mm) demonstrated no differences in lateral displacement when compared with the intact glenoid ( P = .2336 and .2043, respectively). There was no difference in lateral displacement that occurred between the DTA and SSA ( P = .9999). Conclusion: Reconstruction of a large posterior glenoid defect with either a DTA or an SSA can effectively restore glenohumeral stability. Clinical Relevance: This study supports the use of a DTA or SSA in posterior glenoid defect reconstruction. Clinical studies are needed to determine the long-term effects of utilizing such grafts.
机译：背景：经常性胶质骨质不稳定，可以发生后关眼骨缺乏症。据报道，具有远端胫骨同种异体移植物（DTA）的眼盂重建以成功恢复后胶质形状翻译期间发生的接触压力。但是，有关同种异体移植的吸收，可用性和成本的风险。使用肩胛骨自体移植物（SSA）的折叠重建作为相对于后肩部和优选的自体移植特性递过其解剖位置的替代技术。没有已知的先前生物力学研究评估肩胛脊柱作为有效的骨折接枝选择。目的：比较DTA和SSA在与完整的天然神经关节盂相比与大后骨缺陷的静脉内缺损的稳定性进行比较。研究设计：受控实验室研究。方法：测试了十个尸体肩部。通过使用定制Kuka机器人，将50 n-n压缩力施加到Glenohumeral接头上。测量将肱骨顶部超出关节唇缘的峰值的峰值以及后部翻译期间发生的横向位移。测试在5条条件下进行：（1）完整的关节盂和唇盂，（2）模拟反向间隔损伤，（3）12毫米后关骨缺损，（4）用新鲜DTA重建，（5）个关节骨缺损用SSA重建。结果：平均关节宽度为30毫米。平均峰值力和横向位移显着降低了眼盂缺损（分别0.99±2.3 n和0.06±0.09 mm; p <.0001）分别与完整的关节盂（23.00±9.7 n和1.83±0.70mm; p = .0001）。与完整关节盂（P = .9999）相比，DTA（23.00±7.4 n）和SSA（23.00±7.4 n）和SSA（23.00±7.7 n）重建缺损后，峰值力之间没有显着差异（23.00±7.4 n）。 2移植物之间的峰值力没有显着差异（p = .9999）。此外，DTA（1.04±1.09 mm）和SSA（1.02±1.17mm）与完整的关节盂（P = .2336和.2043分别）相比，横向位移的差异显示出没有差异。 DTA和SSA之间发生的横向位移没有差异（P = .9999）。结论：重建具有DTA或SSA的大型后胶瓣缺损，可以有效地恢复胶质形状稳定性。临床相关性：本研究支持在后宫缺损重建中使用DTA或SSA。需要临床研究来确定利用这种移植物的长期影响。

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