Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2010; 77(2):105-111 | DOI: 10.55095/achot2010/020

Modifikovaná Latarjetova operace při recidivujících luxacích ramena u starších pacientůPůvodní práce

R. HART^1,2, P. ŠVÁB¹, J. KREJZLA¹

¹ Ortopedicko-traumatologické oddělení Nemocnice Znojmo

² Klinika traumatologie LF MU v Úrazové nemocnici v Brně

PURPOSE OF THE STUDY:
The aim of this prospective study was to report on an open approach to a bony defect of the glenoid associated with anterior shoulder instability, using a modified Latarjet procedure, in elderly patients.

MATERIAL:
From 2003 to 2005, 11 patients older than 50 years underwent an open Latarjet procedure performed by two senior surgeons. The mean age of the patients was 65 years (range, 51 to 79 years). All of them were available for follow-up examination. There were seven women and four men. The study inclusion criteria were a bony defect of the anterior glenoid confirmed by a CT scan, age over 50 years, and three or more previous dislocations. The mean pre-operative forward elevation was 121.2° ± 16.6° (range, 40° - 180°) and external rotation was 43.3° ± 13.1° (range, 5°- 80°). The mean number of dislocations before surgery was 4.8 (range, 3 - 8).

METHODS:
The Latarjet operation makes use of a large coracoid bone graft to extend the glenoid articular surface by means of a lengthened bone platform, and a sling effect of the conjoined tendon passing through the subscapularis muscle. The Constant-Murley score was used to evaluate the results.

RESULTS:
Shoulder stability and function were restored in all 11 patients at a minimum follow-up of 4 years (range, 49 - 69 months). There was no recurrence of instability. The range of motion was minimally reduced; the mean loss of elevation was 18.8° and the mean loss of external rotation was 4.0°. The mean Constant-Murley score increased from 56.4 ± 13.3 points preoperatively to 81.8 ± 11.3 points post-operatively (p < 0.05). No significant post-operative complications were observed.

DISCUSSION:
It is necessary to differentiate between the Latarjet procedure and its modification popularised by Helfet as the Bristow or the Bristow-Latarjet operation. The Bristow procedure transfers only the tip of the coracoid, along with the attached conjoined tendon, to the anterior side of the neck. This procedure does not treat the bony defect and provides a mere soft-tissue constraint. Only a few reports of the original Latarjet procedure can be found in the international literature.

CONCLUSIONS:
The open Latarjet reconstruction can successfully restore shoulder stability in joints with a significant bony defect of the glenoid even in elderly patients. It is effective in situations in which soft-tissue reconstruction is not a reasonable option.

Klíčová slova: shoulder instability, bony defect, Latarjet procedure

Zveřejněno: 1. duben 2010  Zobrazit citaci