Kim Seung-Ho, Ha Kwon-Ick, Yoo Jae-Chul, Noh Kyu-Cheol
Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
Arthroscopy. 2004 Sep;20(7):712-20. doi: 10.1016/j.arthro.2004.06.012.
The purpose of this article is to report a new clinical entity of posterior instability of the shoulder and the results of its treatment.
Case series.
The Kim's lesion, which is an incomplete and concealed avulsion of the posteroinferior labrum, was arthroscopically identified in 15 patients who presented with posterior or multidirectional posteroinferior instability. Patients were treated by arthroscopic labroplasty and capsular shift. At a minimum follow-up of 2 years, the outcome was evaluated using subjective (pain and function visual analogue scale) and objective (UCLA, ASES, and Rowe scores) measurements.
When visualized under an arthroscope, Kim's lesion apparently had an intact labral attachment and appeared to have a superficial crack at the junction between the articular cartilage of the glenoid and the posteroinferior labrum. However, probing of the lesion revealed detachment of the deep portion of the posteroinferior labrum. The posteroinferior labrum was flat with loss of normal height, which resulted in the retroversion of the chondrolabral glenoid. Incision of the superficial portion of the lesion exposed a loose deep portion of the labrum. Labroplasty was performed to restore the labral height, as well as capsular shift with or without rotator interval closure. The surgical outcome was satisfactory in 14 patients and unsatisfactory in 1 patient. Shoulders were stable in all patients with unidirectional posterior instability. There was 1 recurrence of multidirectional posteroinferior instability.
Kim's lesion is an incomplete avulsion of the posteroinferior labrum, which is concealed by apparently intact superficial portion. The clinical significance of this lesion is the need for surgeons to convert this concealed incomplete lesion to a complete tear and repair it with the posterior band of the inferior glenohumeral ligament. A failure to address this lesion may result in persistent posterior instability.
Level IV, therapeutic, Case Series.
本文旨在报告一种新的肩关节后向不稳的临床实体及其治疗结果。
病例系列。
在15例表现为后向或多方向后下不稳的患者中，通过关节镜检查发现了Kim损伤，即后下盂唇的不完全性隐匿性撕脱。患者接受关节镜下盂唇成形术和关节囊移位术治疗。在至少2年的随访中，使用主观（疼痛和功能视觉模拟量表）和客观（UCLA、ASES和Rowe评分）测量方法评估结果。
在关节镜下观察时，Kim损伤的盂唇附着处表面看似完整，在肩胛盂关节软骨与后下盂唇的交界处似乎有一条浅表裂缝。然而，对该损伤进行探查时发现后下盂唇深部部分已分离。后下盂唇变平，正常高度丧失，导致肩胛盂软骨盂唇后倾。切开损伤的浅表部分后，暴露了盂唇深部的松动部分。进行盂唇成形术以恢复盂唇高度，并进行关节囊移位术，可选择是否闭合旋转间隙。14例患者的手术结果满意，1例患者不满意。所有单向后向不稳的患者肩部均稳定。多方向后下不稳有1例复发。
Kim损伤是后下盂唇的不完全性撕脱，其表面看似完整的部分将其隐匿。该损伤的临床意义在于外科医生需要将这种隐匿的不完全损伤转变为完全撕裂，并使用下盂肱韧带后束进行修复。未能处理该损伤可能导致持续性后向不稳。
IV级，治疗性，病例系列。
