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Scheibel M Nikulka C Dick A Schroeder RJ Gerber Popp A Haas NP 《Archives of orthopaedic and trauma surgery》2008,128(11):1317-1325
Introduction Open reconstruction of severe anteroinferior chronic glenoid defects via a complete subscapularis (SSC) tenotomy using a tricortical
iliac crest bone grafting technique has been reported. The purpose of this study was to evaluate the clinical and radiological
results in patients who underwent this procedure and to investigate the influence of the anterior approach on the structure
and function of the SSC musculotendinous unit.
Materials and methods Ten patients (two women/eight men, mean age 28.7 years) underwent reconstruction of significant chronic glenoid defects in
cases of recurrent shoulder instability with significant glenoid bone loss, using a tricortical autogenous iliac crest in
combination with a capsulolabral repair. The patients were followed up clinically (clinical SSC tests and signs, Constant
score, Rowe score, Walch-Duplay score, WOSI, MISS), by standard radiographs (true a/p, axillary and glenoid profile view),
computed tomography (graft integration, inferior glenoid area) and bilateral magnetic resonance imaging [SSC tendon integrity,
cross sectional area, defined muscle diameters and signal intensity analysis (ratio ISP/upper SSC and ISP/lower SSC)].
Results After a mean follow-up of 37.9 months, the mean Constant score averaged 88.3 points, the Rowe score 89.5 points, the Walch-Duplay
score 83.5 points, the MISS 80.6 points and the WOSI 82.6%. No recurrent subluxations or dislocations were observed. Clinical
signs for SSC insufficiency were present in 80% of cases. Two patients had grade I and one patient grade II osteoarthritis
according to Samilson and Prieto classification. CT imaging revealed a consolidated autograft in all cases with an 18.4% increase
of the inferior glenoid area postoperatively (P < 0.05). No tendon ruptures were found. MR imaging revealed muscular atrophy (P < 0.05) and fatty infiltration of the SSC (P > 0.05) muscle compared to the contralateral side.
Conclusion Open reconstruction of anteroinferior chronic glenoid defects via a complete SSC tenotomy using an iliac crest bone grafting
technique allows an anatomic reconstruction of the anteroinferior glenoid with good and excellent clinical results. The anterior
approach may lead to atrophy and fatty infiltration of the SSC muscle despite an intact tendon. However, this did not affect
the results in terms of stability. 相似文献
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《Seminars in Arthroplasty》2014,25(1):38-43
Inaccurate placement of glenoid prosthesis in shoulder arthroplasty can lead to early loosening, instability, and failure. To address difficult glenoid morphology, patient-specific instrumentation and navigation techniques have been developed. Advanced imaging data has demonstrated utility in preoperative decision making. Cadaveric studies have subsequently shown that the application of advancing imaging and navigation can lead towards increased accuracy with prosthesis placement. Clinical trials have also shown increased accuracy with navigation and advanced imaging, but data demonstrating improved long-term outcomes and decreased complication rates is not yet available. This technology continues to evolve as a method to address glenoid bone loss and abnormal morphology. 相似文献