肩关节前向不稳伴关节盂骨缺损的研究进展

Research advances on anterior shoulder instability associated with glenoid bone defect

肩关节前向不稳是一种多因素参与的肩关节病变，治疗较为困难，尤其为伴关节盂骨缺损时。较小的骨缺损对肩关节稳定性的影响不明显，但是随着骨缺损程度增加，关节不稳的发生率也会显著增高。关节盂缺损，20％～25％时，需考虑行关节盂重建，以改善关节盂的形态、提高关节稳定性。目前对于关节盂骨缺损的分类、分型尚无统一的方法，既往学者报告的相关分型方法均未得到广泛的临床应用。针对测量计算关节盂骨缺损、量化缺损的严重程度，既往研究较常用的为Pieo测量法。早期对于关节盂骨缺损选择何种治疗方式时，通常要考虑其损伤的程度。对于急性损伤，直接修复骨折的效果较好；慢性损伤往往不能发现骨折块，通常需要进行骨缺损重建。目前较常用的关节盂重建术式包括Bristow术、Latarjet术和Eden—hybinette术，鉴于Latarjet术比Bristow术能提供附加的骨阻挡作用，从而得到更好的稳定性，Latarjet术在临床应用更广；Eden．hybinette术不需要截取喙突，对正常解剖结构的影响较小，但是同样也缺失了联合腱的悬吊稳定作用，而且植入骨块缺乏血运，存在被吸收的风险。行此3种术式后均发现肩关节炎发生率增高，故需要在应用中不断改进或者提出更为优良的手术方式。肩关节前向不稳伴骨缺损治疗通常较棘手，各种方式均具有优、缺点，应根据患者的情况选择最合适的治疗方法。

Anterior shoulder instability is a very difficult issue to treat, especially with glenoid bone defect. When the de- fect is small, there is little influence on shoulder instability. The larger the defect is, the more influence there will be. Most authors agree that glenoid bone reconstruction should be considered when glenoid bone defect is more than 20%-25%. In this condition soft tissue procedures alone are not enough to provide stability to the shoulder. To date, there is still not an ideal typing of glenoid bone defect. There are many methods of assessing the size of bone defect. Pico system is one of the most common methods, as it is easier and more precise. Numerous surgical procedures have been described to address the bone defect. The Bristow procedure, the Latarjet procedure and the Eden-hybinette procedure are effective and most popular around the world. The Latarjet procedure can provide more bone blocking than the Bristow procedure, and is more popular. The Eden-hybinette procedure dose not need cor- acoid transfer and then has no damage of normal anatomical structure. But it also lack the hanging effect of the conjoint tendon. Af- ter all, each procedure has its advantage and disadvantage in treating anterior shoulder instability associated with glenoid bone de- fect and should be chosen depending on the characteristics of each patient and the preference of each surgeon. Furthermore, more new and effective treatments are still needed.