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Operativer Zugang zum Schultergelenk

Die Tuberculum-minus-Osteotomie

Surgical approach to the shoulder

Lesser tuberosity osteotomy

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Zusammenfassung

Die Tuberculum-minus-Osteotomie bietet für den deltopektoralen Zugang zum Schultergelenk eine gute Übersicht und ermöglicht eine suffiziente anatomische Refixation der M.-subscapularis-Insertion. Die klinischen und biomechanischen Studien lassen jedoch nicht schlussfolgern, dass eine Tuberculum-minus-Osteotomie mit transossärer Refixation eine höhere maximale Versagenslast, weniger Elongation nach zyklischer Belastung und ein besseres klinisches Outcome der Patienten im Vergleich zur M.-subscapularis-Tenotomie mit Tenodese erbringt. Ein Vorteil der Osteotomie kann die radiologische Evaluierbarkeit der Sehnenadaptation bzw. des osteotomierten und refixierten Knochenchips sein. Bei der transossären Refixation kann eine Schaftsicherung der Fäden einen Vorteil bieten, wobei der Schaft in eine Fadenschlaufe implantiert wird. Dadurch wird ein Durchschneiden der Fäden durch den Knochen vermieden, da die Fäden hinter dem Implantat verlaufen. Die Fadenfixierung wird hierbei bei zementierten Schäften noch verstärkt. Bei der Wahl der Desinsertion der M.-subscapularis-Sehne sollte die Evaluierung der Knochenqualität des Tuberculum minus und die Qualität der Sehne am Ansatz eine Rolle spielen.

Abstract

Osteotomy of the lesser tuberosity for the surgical delto-pectoral approach to the glenohumeral joint results in good visualization and overview and sufficient anatomical refixation of the insertion of the subscapularis muscle. However, clinical and biomechanical studies have not shown clearly significantly better results for osteotomy concerning ultimate load to failure, displacement after cyclic loading and outcome in patients compared with tenotomy and tenodesis of the subscapularis tendon. One advantage of osteotomy, however, is the potential radiological evaluation of the refixation with healing of the bony fragment. In the context of refixation, securing of the sutures behind the stem during implantation can be beneficial because it prevents sutures cutting through the bone. This benefit is increased in cemented stems by means of better suture fixation. With respect to the choice of osteotomy or tenotomy, the bony substance and tendon quality of the insertion of the subscapularis muscle should be evaluated.

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Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

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Correspondence to Dr. T. Patzer.

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Patzer, T., Ziskoven, C. & Krauspe, R. Operativer Zugang zum Schultergelenk. Orthopäde 42, 356–363 (2013). https://doi.org/10.1007/s00132-012-2012-x

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Schlüsselwörter

  • Schulterzugang
  • M. subscapularis
  • Schulterendoprothetik
  • Tenotomie
  • Elongation

Keywords

  • Surgical approach shoulder
  • Subscapularis muscle
  • Shoulder replacement
  • Tenotomy
  • Elongation