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外文期刊>Orthopaedic Journal of Sports Medicine
>Restoration of the Posterior Glenoid in Recurrent Posterior Shoulder Instability Using an Arthroscopically Placed Iliac Crest Bone Graft: A Computed Tomography–Based Analysis
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Restoration of the Posterior Glenoid in Recurrent Posterior Shoulder Instability Using an Arthroscopically Placed Iliac Crest Bone Graft: A Computed Tomography–Based Analysis
Background: Posterior shoulder instability is uncommon, and its treatment is a challenging problem. An arthroscopically assisted technique for posterior iliac crest bone grafting (ICBG) has shown promising short- and long-term clinical results. Changes as shown on imaging scans after posterior ICBG for posterior shoulder instability have not been investigated in the recent literature. Purpose: To evaluate changes on computed tomography (CT) after arthroscopically assisted posterior ICBG and to assess clinical outcomes. Study Design: Case series; Level of evidence, 4. Methods: Patients with preoperative CT scans and at least 2 postoperative CT scans with a minimum follow-up of 2 years were included in the evaluation. Of 49 initial patients, 17 (follow-up rate, 35%) met the inclusion criteria and were available for follow-up. We measured the glenoid version angle and the glenohumeral and scapulohumeral indices on the preoperative CT scans and compared them with measurements on the postoperative CT scans. Postoperatively, graft surface, resorption, and defect coverage were measured and compared with those at early follow-up (within 16 months) and final follow-up (mean ± SD, 6.6 ± 2.8 years). Results: The mean preoperative glenoid version was?–17° ± 13.5°, which was corrected to?–9.9° ± 11.9° at final follow-up ( P & .001). The humeral head was able to be recentered and reached normal values as indicated by the glenohumeral index (51.8% ± 6%; P = .042) and scapulohumeral index (59.6% ± 10.2%; P & .001) at final follow-up. Graft surface area decreased over the follow-up period, from 24% ± 9% of the glenoid surface at early follow-up to 17% ± 10% at final follow-up ( P & .001). All clinical outcome scores had improved significantly. Progression of osteoarthritis was observed in 47% of the shoulders. Conclusion: Arthroscopically assisted posterior ICBG restored reliable parameters as shown on CT scans, especially glenoid version and the posterior subluxation indices. Graft resorption was common and could be observed in all shoulders. Patient-reported clinical outcome scores were improved. Osteoarthritis progression in almost 50% of patients is concerning for the long-term success of this procedure.
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机译：背景：后肩关节不稳定是罕见的，其治疗是一个具有挑战性的问题。用于后髂嵴骨移植的关节镜辅助技术（ICBG）已经显示出有希望的短期和长期的临床结果。作为后肩不稳定后ICBG后成像扫描中所示的改变并没有在最近的文献进行了研究。目的：为了评估计算机断层扫描（CT）后关节镜下后ICBG变化和评估临床结果。研究设计：案例系列;证据等级4.方法：患者术前CT扫描，并用最短随访2年至少2次术后CT扫描，包括在评估中。 49初始名患者中，17（随访率，35％）符合纳入标准，并可供后续。我们测量关节盂扭转角和术前CT扫描肩关节肩关节和指标，并与术后CT扫描测量进行了比较。手术后，接枝表面，吸收，和缺陷覆盖率进行测定，并与那些在早期随访（16个月内）和最终随访（平均值±SD，6.6±2.8岁）。结果：平均术前关节盂版本是-17°±13.5°，将其校正至-9.9°±11.9°在最终随访（P＆LT; 0.001）？。肱骨头能够被重新定和由盂肱索引指示达到正常值（51.8％±6％; P = 0.042）中的最终后续和肩关节指数（0.001 59.6％±10.2％; P＆LT）向上。接枝表面积减少在随访期间，从24％±关节盂表面的9％在早期后续17％±10％在最终随访（P＆LT; 0.001）。所有临床结果的分数已经显著改善。在肩部的47％中观察到骨关节炎的发展。结论：关节镜下后ICBG恢复可靠的参数CT扫描，特别是关节盂版本和后半脱位指数，如图所示。移植物的吸收是常见的，在所有的肩膀可以观察到。患者报告的临床结果分数提高。患者近50％的骨关节炎的进展是关于此过程的长期成功。
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