肩關節前向的不穩定，是肩關節疾患中常見的診斷，而肩盂的骨頭缺損則是在處理肩關節前向不穩定時常會面臨到的一個困難。喙突移位術(Latarjet 手術)主要用於因肩盂之骨頭缺損所造成的肩關節不穩定，此手術可以開放式手術或以關節鏡行之。此手術主要是將喙突(Coracoid process)的平行部分切除下來，連同附著的肌腱一起轉移到肩盂(Glenoid)的前緣，並以兩支螺絲固定。此手術的高成功率來自於三個不同的影響：1、附著於喙突上的聯合肌腱在轉位後，可以限制肩胛下肌(Subscapularis muscle)在外展及外旋時的活動；2、移植過來的喙突可以增加肩盂的關節接觸面；3、手術同時也會將關節囊修復。

在 Latarjet 手術中，移植骨的位置及兩支螺絲的方向是決定關節穩定度及長期併發症之決定性因子。有些醫師認為，術中的螺絲必須和肩盂的關節面完全平行，才能夠減少移植的喙突向外突出於關節面(overhang)，同時也能減少脊上神經(suprascapular nerve)受傷的風險。然而，因為喙突的內緣有許多神經血管結構，且肩盂的關節面與人體的胸腔呈現傾斜的角度，因此要將螺絲固定平行於關節面在手術技巧上有一定的困難。即使是過去的文獻，螺絲與關節面的角度(即 α angle)大多都在 0 度到 40 度之間，而平均值大約在 10 到 20 度左右。

因此，本研究的目的，是希望進行一個生物力學實驗，比較在 Latarjet 手術中，不同的螺絲方向(0 度、15 度及 30 度)，是否會影響移植骨固定的穩定度以及承受破壞的強度。本研究假設在使用肩部大體來進行 Latarjet 手術時，將移植的喙突固定在稍大的 α angle 下，仍能夠和固定於較小的 α angle 時，有同樣的穩定性及破壞強度。

本研究結果發現，在使用肩部大體來進行 Latarjet 手術時，α angle 越大，其肩盂和移植骨之間的位移有逐漸增加之趨勢。且將螺絲固定在與關節面呈 30 度時，較固定在與關節面平行之狀況下，其肩盂和移植骨之間的位移，會達到統計上的顯著差異。除此之外，所有的檢體遭受破壞的原因均是螺絲切穿肩盂的切面，且破壞的荷重在三組間並沒有顯著的差異。

根據本研究的結果可以得到結論如下：在 Latarjet 手術中，雖然螺絲與關節面的交角等於 15 度時，並不影響生物力學上的穩定度，術者仍應盡可能將螺絲固定於和關節面平行之方向。但術者應避免螺絲與關節面的交角達到 30 度。

Shoulder instability is one of the commonly diagnosed and treated shoulder disorders, and glenoid bone loss is a common finding in patients with an anterior
shoulder instability. The Latarjet procedure is a surgical technique to treat recurrent
shoulder instability with significant glenoid bone loss and it can be performed either arthroscopically or open. This procedure involves osteotomy of the coracoid process, then transferred distally and secured to the glenoid bony defect with 2 screws. The procedure has a high success rate, and this is due to the ‘triple effect’ including 1) the conjoint tendon reinforces the inferior subscapularis and restricts the shoulder joint from abduction and external rotation; 2) increase and restore the contact surface area; 3) concomitant repair of the joint capsule.

When performing the Latarjet procedure, accurate screw direction is the key to
provide stability and prevent complications. Some surgeons statement that the screw must be completely parallel to the glenoid surface to reduce the risk of suprascapular nerve injury and graft overhang laterally. However, placement the screws parallel to the glenoid surface is techniqually challenged because of the nearby neurovascular structure and the obliquity of the scapula on the thorax. The reported angle between screw and glenoid surface (α angle) ranged from 0 to 40 degrees and with average around 10 to 20 degrees in previous literature.

The aim of this study was to examine and compare the biomechanical property
between different screw fixation angle (0, 15 and 30 degrees) for Latarjet procedure in cadaver specimen. It was hypothesized that placement of the screws with slightly larger α angle would obtain similar fixation stability and failure strength than that with small α angle in human cadaver specimens while performing Lartajet procedure.

The results of presented study revealed that there was a trend of increased displacement when increased α angle. A significant larger glenoid-graft interface displacement was noted when placing the screws with 30 degrees α angle compared with placing the screws with 0 degrees α angle. The ultimate failure load was similar when placing the screws with 0, 15 and 30 degrees, and all specimens failed through screw cutout from the glenoid.

The conclusion suggested that when performing the Latarjet procedure, surgeons
should try to apply the screws as parallel as possible to the glenoid articular surface. Mild deviation, that α angle less than 15 degree, may not reduce the fixation stability, but excessive cases of more than 30 degrees α angle should be avoid.

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