科研之友
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摘要
Anterior instability after total shoulder replacement is a rare but potentially devastating complication. The reported incidence ranges from 0-29%, with an average incidence of 2.8%.(26) Cuomo and Checroun reported that instability represented 38% of all complications related to total shoulder arthroplasty (TSA).(7) Anterior instability is the most common type, and determining the cause can be difficult. When evaluating a patient with an unstable TSA, the surgeon must take into account soft-tissue deficiencies, bone loss, and component positioning. Often, the problem is multi-factorial in nature. If the patient has pain and/or poor function as a result of instability, revision surgery may be indicated. However, the results of revision surgery for this problem are less than ideal, and instability persists in a significant number of patients.(3,5,9,13,20,21,26)
In cases where component positioning is adequate and the components are stable, anterior instability is usually associated with subscapularis tendon disruption.(3,9,13,18,19,26) Most patients are symptomatic, reporting weakness and/or pain, even though they may not experience a complete shoulder dislocation. Static anterior subluxation may also be evident on plain radiographs or computed tomography (Figure 1). In these cases, surgical treatment may be indicated. Reported options for treatment have included reverse prosthesis,(4,12,28) subscapularis reconstruction,(18,24) pectoralis major tendon transfer,(15,23,25,29) and autograft or allograft reconstruction of the anterior capsule.(1,14,27) In our experience, subscapularis repair is usually not possible and pectoralis major tendon transfer does not re-center the humeral head if static anterior subluxation is present. Reverse shoulder prosthesis is a reliable salvage procedure; however, it may require removal of well fixed total shoulder components. Furthermore, this option is generally not indicated in young patients.(12)
The Latarjet procedure(2,6,16,22) is a technique that has been shown to reliably restore anterior shoulder stability not only in primary instability but also in revision settings, where both bone and soft tissue loss are important factors. The procedure works as a static bony block and a dynamic tendinous sling.(8,22)
We hypothesized that a modified Latarjet procedure would restore static stability to the total shoulder prosthesis as well as maintain stability during active shoulder motion principally through its action as a dynamic sling. We report on 2 cases where this procedure resulted in successful stabilization of an unstable shoulder arthroplasty.
- 出版日期2010-3
