肩部不稳定手术失败:最新技术。

IF 3.3 Q1 ORTHOPEDICS
Gonzalo Luengo-Alonso, Raffy Mirzayan, Joo Han Oh, Deepak Bhatia, Emilio Calvo
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引用次数: 0

摘要

手术稳定失败后复发性肩部不稳定是一种致残和复杂的情况。随着时间的推移,临床研究重塑了传统的方法,强调了理解患者特定因素、准确诊断和解剖重建的重要性。全面的评估对于确定手术失败的原因至关重要,这通常包括患者相关因素(如年轻、男性、多发脱位和手术延迟)、漏诊(包括肩关节骨丢失、Hill-Sachs病变和囊膜松弛)和技术错误(如锚定位不当或固定不充分)。高质量的计算机断层扫描(CT)和磁共振成像(MRI)关节成像对于评估肩关节和肱骨缺损、软组织完整性和相关病变至关重要。虽然Latarjet手术仍然是肩关节骨重建中最广泛使用的技术,但髂骨的游离骨移植或胫骨远端等异体骨移植的应用越来越多。关节镜下关节囊修复有或没有复位手术,在亚临界骨丢失和保留软组织质量的患者中显示出有希望的结果。然而,亚临界骨质流失的定义差异很大,使治疗算法复杂化。特殊人群,如老年患者、癫痫患者或高需求运动员,构成了额外的挑战,需要个性化的策略。对于合并不稳定和袖带缺陷的老年患者,反向肩关节置换术已成为一种救助性选择。在运动员中,骨块手术通常比单纯的软组织修复提供更可靠的结果。尽管外科技术、植入物和成像技术有了进步,但仍有几个问题尚未解决。亚临界骨丢失的最佳治疗缺乏共识,比较技术的高水平证据有限,结果定义的可变性。未来的研究应旨在标准化肩部不稳定的治疗,以建立一个更可重复的、有长期数据支持的系列。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
FAILED SHOULDER INSTABILITY SURGERY: STATE OF THE ART.

Recurrent shoulder instability after failed surgical stabilization is a disabling and complex condition. Over time, clinical research has reshaped traditional approaches, emphasizing the importance of understanding patient-specific factors, accurate diagnosis, and anatomical reconstruction. A comprehensive evaluation is essential to identify failure causes, which typically include patient-related factors (such as young age, male sex, multiple dislocations, and delayed surgery), missed diagnoses (including glenoid bone loss, engaging Hill-Sachs lesions, and capsular laxity), and technical errors (such as malpositioned anchors or insufficient fixation). High-quality imaging with computed tomography (CT) and magnetic resonance imaging (MRI) arthrograms is critical for assessing glenoid and humeral bone defects, soft tissue integrity, and associated lesions. While the Latarjet procedure remains the most widely used technique for glenoid bone reconstruction, free bone grafts from the iliac crest or allografts like distal tibia are increasingly utilized. Arthroscopic revision capsulolabral repair with or without the remplissage procedure has shown promising outcomes in selected patients with subcritical bone loss and preserved soft tissue quality. However, the definition of subcritical bone loss varies widely, complicating treatment algorithms. Special populations, such as elderly patients, those with epilepsy, or high-demand athletes, pose additional challenges and require individualized strategies. Reverse shoulder arthroplasty has emerged as a salvage option in older patients with combined instability and cuff deficiency. In athletes, bone block procedures often provide more reliable outcomes than soft tissue repairs alone. Despite advances in surgical techniques, implants, and imaging, several issues remain unresolved. There is a lack of consensus on optimal treatment for subcritical bone loss, limited high-level evidence comparing techniques, and variability in outcome definitions. Future research should aim to standardize shoulder instability treatment to create a more reproducible series supported by long-term data.

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来源期刊
CiteScore
2.90
自引率
6.20%
发文量
61
审稿时长
108 days
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