Cirugía de Latarjet abierta con técnica mini-open: revisión de conceptos actuales
DOI:
https://doi.org/10.1016/j.rccot.2015.04.001Palabras clave:
luxación del hombro, inestabilidad de la articulación, articulación del hombro/cirugía, procedimientos ortopédicos/métodosResumen
La incidencia de inestabilidad traumática del hombro es de 1,7% en la población general. La estructura ósea del hombro le confiere una inestabilidad inherente. Para la evaluación inicial debe aclararse la edad, la dominancia y la actividad del paciente, así como el número y la dirección de las luxaciones y las condiciones generales de los tejidos. Las radiografías iniciales son la anteroposterior y la proyección axilar o de Velpeau; en caso de lesión ósea se recomienda la proyección anteroposterior con rotación interna, de Stryker, o la axilar. La resonancia nuclear magnética (RMN) permite estudiar lesiones asociadas. Entre los múltiples tratamientos descritos, la reparación artroscópica tipo Bankart es la más usada. En el 90% de los casos de inestabilidad anterior recurrente del hombro se ha reportado un defecto glenoideo anterior, que requiere otros métodos de tratamiento como la transferencia de la coracoides, indicada también en caso de defecto óseo glenoideo y ruptura del subescapular. La técnica quirúrgica ha demostrado ser reproducible a través de los años, y el proceso de rehabilitación acelerado ha permitido el retorno deportivo temprano de los pacientes. Las complicaciones son casi todas secundarias a errores técnicos. Estudios recientes reportan un alto grado de satisfacción y solo el 1% de revisión; no obstante, se considera que no hay evidencia suficiente para considerarla superior a otras en caso de defecto óseo, a pesar de reportarse mejores resultados con la técnica de Bristow-Latarjet frente a otras técnicas con respecto a la valoración subjetiva de la movilidad, la estabilidad y pruebas funcionales subjetivas.
Nivel de evidencia: IV
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