Die J-Span Plastik nach Resch bei posttraumatischer unidirektionaler Schulterinstabilit.Kurz- bis mittelfristige klinische Ergebnisse und deren Vergleich mit veröffentlichten Ergebnissen alternativer Operationsverfahren.

In der Vergangenheit wurden bezüglich der operativen Behandlung der posttraumatisch rezidivierenden vorderen Schulterluxation zahlreiche Operationsverfahren entwickelt. Aus der Vielzahl der verschiedenen Operationsverfahren haben sich diesbezüglich nur vier Konzepte mit vielen Modifikationen durchge...

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Bibliographic Details
Main Author: Hemme, Sven
Contributors: Fuchs-Winkelmann, Susanne (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2007
Online Access:PDF Full Text
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Several operation procedures for recurrent anterior shoulder luxation have been developed. From the multiplicity of the different operation procedures in this connection only four concepts became generally accepted. Ventral soft tissue instability is one of the most common reasons of recurrent anterior shoulder luxation. According to the extend of soft tissue damage in the area of the anterior glenoid one operation method shows satisfactory postoperative results. Approved operative methods for shoulder joint stabilisation aim for the anatomical reconstruction and removal of pathological structures. A need for stabilising shoulder joint surgery results from constitutional instability, non-repairable anatomical or revision surgery defects. The Orthopaedic Department of the Barmbek Hospital performed Resch’s J-Chip plastic surgery in patients with recurrent traumatic ventral shoulder instability with large osseous glenoid lesions and glenoids with low diameter. Aim was the anatomical reconstruction of pathological changes of the vetrocaudal glenoid as a result of recurrent shoulder luxation. Between 1996 and 2002 17 patients with recurrent traumatic anterior shoulder instability were treated with Resch’s J-Chip plastic operation. Due to laxity of the shoulder joint in preoperative examination Neer’s Capsule-T-Shift was performed. 13 of these patients were followed up over an average time of 35 ± 24 months (5-89 months). The average operated patient’s age was 35 ± 12 years (19-57 years). According to both subjective and objective evaluation three different shoulder function scores with differing distribution of the subjectivity and/or objectivity were used: CONSTANT- , ROWE- and ASES Score. An improvement in post-operative score evaluation was seen in every score. A significant reduction of the external rotation showed up both with 0 degrees and with 90 degrees of abduction in comparison to physiological shoulder joints. Furthermore there was an increase of the arthrotis of 0 to 1 degree after Samilson in the follow up period of 35 ± 24 months (5-89 months) with 4 of 13 patients. In all 13 cases an osseous integration of the bony chip has been seen. The TGHI increased significantly (p < 0,001) of praeoperativ on the average 0.54 ± 0.05 (0.44 - 0.55) on post postoperative on the average 0.72 ± 0.06 (0.62 - 0.79). After surgery there was no apprehension sign larger than 1st degree lesion seen. Comparing our results with other studies regarding anterior stabilizing procedures in view of relapse, omarthritis and external rotation deficits there was no further postoperative luxation and therefore compared with other stabilising procedures good midterm results. Concerning external rotation deficits a relatively high rate shows up in this study compared with other stabilising procedures. The external rotation must be potentially considered thus as the function of the joint restrictive factor. A comparison of the omarthritis ratio in this study with other osseous stabilization procedures (chip-plastics, bone-block-transfers-, derotation-ostetomies) is to that extent difficult, since it concerns short to midterm results here. To what extent these results will develop on a long-term basis and whether they are comparable with results specified so far in the literature remains to be seen. Resch’s J-Chip plastic as surgical procedure in traumatic recurrent anterior shoulder joint instability is not to be seen as state of the art. It complements other surgical approaches. In cases of anterior shoulder joint instability with large osseuous glenoid lesions or low diameter glenoids a repair of the Bankert Perthes lesion only is not recommended, since in low diameter glenoids the lacking glenoid cavity reconstruction results in a lack of stability. Under this circumstances Resch’s J-Chip plastic is a possible surgical approach.