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Tecnica de latarjet. inestabilidad de hombro. artroscopia de hombro

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pacientes con luxación recurrente de hombro, o inestabilidad glenohumeral que requieren operación de hombro,

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Tecnica de latarjet. inestabilidad de hombro. artroscopia de hombro

  1. 1. DR. CORTEZ SOTO, JOSE ALBERTO HNERM SETIEMBRE - 2015
  2. 2.  Conceptos de pera invertida, Hill Sachs y gleonid track.  Métodos diagnósticos.  Indicaciones de la técnica.  Técnica quirúrgica. 2B3, Latarjet modificado (arco congruente). Latarjet clásico.
  3. 3.  Walter Rowley Bristow (Inglaterra)1882 – 1947.  Michael Latarjet (Francia) 1919 – 1999.  Latarjet publico su trabajo en 1954 y Helfet en 1958 publico el procedimiento de Bristow
  4. 4. La perdida de la congruencia articular se puede producir por: - Bankart óseo, “Pera Invertida”. - Lesión de Hill-Sachs de enganche. Tratamiento de la Inestabilidad Anterior de Hombro Asociada a Grandes Defectos Óseos Dr. Stephen S. Burkhart, Dr. Richard Duey ARTROSCOPIA | VOL. 19, Nº 1 : 18-27 | 2012
  5. 5. 194 pacientes: Recurrencia sin perdida ósea 4% Recurrencia de luxación con perdida ósea 67% Defecto óseo – pera invertida 61% Defecto Hill Sachs enganchante 100%
  6. 6.  Sin defecto óseo: 6,5 % recurrencia  Con defecto óseo: 89% recurrencia EN JOVENES QUE PRACTICAN DEPORTE DE CONTACTO SE ENCONTRON:
  7. 7.  Luxación en abducción y rotación externa , la muesca es paralela a la glenoides y se enganchara en abd y re.
  8. 8. La luxación se da con ligera abducción y extensión la muesca será perpendicular a la glena y al colocarse en abd y re no enganchara
  9. 9. ISIS MAYOR DE 7 PUNTOS – RECURRENCIA DE 70% ISIS MENOR DE 6 PUNTOS – RECURRENCIA DE 10% ISIS MENOR DE 3 PUNTOS – RECURRENCIA DE 5 %
  10. 10. GLENOIDEO Pera invertida por compactación Bankart Oseo HUMERAL Hill Sachs con enganche Hill Sachs sin enganche
  11. 11.  Rx serie traumática, west point.  Tac 3d.  Rnm  Artroscópico
  12. 12. ¿Qué técnica Qx utilizar? 1.- Nivel de actividad- demanda del paciente, si el paciente hace actividad deportiva. 2.- Perdida ósea: 20 – 25 % 3.- Calidad de partes blandas (hiperlaxitud, ALPSA, HAGL) 4.- Cirugía de revisión
  13. 13.  Tecnica artroscópica Bankart – Bristow – Latarjet y el triple bloqueo. (2B3). Pascal Boileau 2010. La Fosse 2007.  Tecnica de Latarjet modificada (arco congruente). Burkhart 2007.  Tecnica de Latarjet Clasica
  14. 14.  1. Bony efecto  2. Belt efecto  3. Bumper efecto Orthop Clin North Am. 2010 Jul;41(3):381-92. doi: 10.1016/j.ocl.2010.03.005. Arthroscopic Bankart-Bristow-Latarjet (2B3) Procedure: How to Do It and Tricks To Make it Easier and Safe. Boileau P1, Mercier N, Old J.
  15. 15. Shoulder arthroscopy. Third edition Stephen J. Snyder, 2015
  16. 16. A. Defecto óseo B. Técnica latarjet modificada (Burkhart and De Beer) C. Técnica clásica de Latarjet
  17. 17.  Cirugía de Latarjet: 25% - Infección - Hematoma - Inestabilidad - Daño neurológico: nervio musculocutaneo, n. radial y n. axilar.
  18. 18.  Determinar componente óseo ( pera invertida, hill sachs,) glenoid track.  Conocer el estado de partes blandas asociadas.  Preferimos seguir con la técnica quirúrgica de Latarjet clásica.  Recordar si tenemos perdida de 25% de glena y lesión de Hill Sachs de enganche, la cirugía a cielo abierto es la elección, (técnica de Latarjet).
  19. 19. Gracias por su atención

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