1 / 20

ECHEC DU TRAITEMENT ARTHROSCOPIQUE

EVALUATION RADIOLOGIQUE DES PERTES DE SUBSTANCE OSSEUSE DE LA GLENE DANS L'INSTABILITE ANTERIEURe DE L'EPAULE Radiographic Analysis of GLENOIDAL Bone Defects in Chronic Anterior Shoulder Instability. ECHEC DU TRAITEMENT ARTHROSCOPIQUE. Taux de récidives: 6 – 25% Autres techniques

oral
Download Presentation

ECHEC DU TRAITEMENT ARTHROSCOPIQUE

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. EVALUATION RADIOLOGIQUE DES PERTES DE SUBSTANCE OSSEUSE DE LA GLENE DANS L'INSTABILITE ANTERIEURe DE L'EPAULERadiographic Analysis of GLENOIDAL Bone Defects in Chronic AnteriorShoulder Instability

  2. ECHEC DU TRAITEMENT ARTHROSCOPIQUE • Taux de récidives: 6 – 25% • Autres techniques • BANKART A CIEL OUVERT: 10% • BUTEE PRE GLENOIDIENNE: 5% • Nicholasg. h. Mothadi, Ivan j. Bitar , trenty Sasynuik ,M Hollinshead, Harper. open repair for traumatic anterior shoulder instability:A Meta-analysis.Arthroscopy vol 21, 6 , 2005 : p652-658 • Carreira , Mazzocca , Oryhon , Brown , Hayden , Romeo . A prospective outcome evaluation of arthroscopic Bankart repairs: minimun 2-years follow-up. Am J Sports Med. 2006 May; 34 (5): 771-7.  • Tan, Guisasola, Machani B, Kemp G, Sinopidis C, Brownson P, Frostick S. Arthroscopic stabilization of the shoulder: A prospective randomized study of absorbable versus nonabsorbable suture anchors. Arthroscopy. 2006 Jul; 22 (7): 716-20

  3. FACTEURS DE RECIDIVE Qualité des parties molles réinsérées Lésions Osseuses: Humérales: Hill- Sachs Bord antérieur de la glène Burkhart S, De Beer F : Traumatic Glenohumeral bone defects and tir relationship to failure of arthroscopic Bankart repairs: Significance of the inverse Pear glenoid and the humeral engaging Hill Sachs lesion. Arthroscopy vol 16, 7 octobre 2000: p 677-694.

  4. DEFECT OSSEUX HUMERAL Profondeur et/ou Largeur encoche > 3,9mm (HIROMOTO) Profondeur encoche/ rayon de la tête > 21% (HARDY) • Hiromoto Ito, Akinori Takayama, Yasumasa Shirai. Radiographic evaluation of the Hill-Sachs lesion in patients with recurrent anterior shoulder instability . • J Shoulder Elbow Surg nov/dec 2000: P 495-497. • Conso C, Hardy P Arthroscopic treatement of anterior glenohumeral instability. Chir main .2006 Nov; 25s1:S82-S90.

  5. DEFECT OSSEUX GLENOIDIEN Compression BonyBankartlesion

  6. DEFECT OSSEUX GLENOIDIEN Centre cercle - bord antérieur/diamètre Surface defect/surface cercle

  7. DEFECT OSSEUX GLENOIDIEN

  8. DEFECT OSSEUX GLENOIDIEN R = B/2A B=Distance bd post-bd ant A=Rayon

  9. DEFECT OSSEUX GLENOIDIEN PROFILBERNAGEAU PROFILDEPASSE

  10. DEFECT OSSEUX GLENOIDIEN

  11. SERIE • 10 Patients • Six hommes/4 femmes • Âge moyen=29ans (20-35ans) • Instabilité Antérieure Épaule • Épaule controlatérale saine +++ • Mesures: • BERNAGEAU COMPARATIF • SCANNER 3D • MESURE PER OPERATOIRE (Bare Spot)

  12. SERIE R=A-B/A

  13. RESULTATS: POURCENTAGE DE DEFECT

  14. RESULTATS: ECART MOYEN 0,1% (-10/13%) 0,61% (-2/2,78%) 1,47% (-10,6/11)

  15. DISCUSSION • Burkhart: 194 Bankart sous arthro. 61% récidives si lésion glène 4% récidives si glène saine • Récidive : ITOI 21% BIGLIANI 25% • Burkhart S, De Beer F : Traumatic Glenohumeral bone defects and its relationship to failure of arthroscopic Bankart repairs: Significance of the inversePear glenoid and the humeral engaging Hill Sachs lesion. Arthroscopy vol 16, 7 octobre 2000: p 677-694. •  Itoi, Eiji, Lee, Seok-bon Berglund, Kai-nan An. The effect of a glenoid defender on anteroinferior stability of the shoulder after Bankart repair: A cadaveric study. J B J S .82-A. 2000: P 35-46. • Bigliani LU, Newton PM , Steinmann SP , Connor Pm . Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med 1998:26:41-45.

  16. DISCUSSION: mesure per-op • Per-op VS scanner 3D et Bernageau: • Bare spot: limites ??? • Bord post camouflé par parties molles • Voie d'abord postéreure haut située

  17. DISCUSSION: scanner 3D • Coût élevé • Disponibilité +/- • Difficultés techniques: • Coupe dans le plan de la glène • Positionnement manuel des cercles

  18. DISCUSSION: Bernageau • Reproductibles • Mesure immédiate • LIMITE : Epaule contro-ltérale saine

  19. CONCLUSION • Bilan Rx simple suffit: • Face en double obliquité (3 rotations) • Bernageaux comparatifs • Le scanner 3D n'est plus indisponsable, sauf pour lésions bilatérales • Résultats statistiquement insignifiants: poursuivre l'étude

More Related