Ruckstuhl Heidi, de Bruin Eling D, Stussi Edgar, Vanwanseele Benedicte
Department of Mechanical and Process Engineering, Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland.
BMC Musculoskelet Disord. 2008 Jul 23;9:107. doi: 10.1186/1471-2474-9-107.
Any cartilage damage to the glenohumeral joint should be avoided, as these damages may result in osteoarthritis of the shoulder. To understand the pathomechanism leading to shoulder cartilage damage, we conducted a systematic review on the subject of articular cartilage lesions caused by traumas where non impression fracture of the subchondral bone is present.
PubMed (MEDLINE), ScienceDirect (EMBASE, BIOBASE, BIOSIS Previews) and the COCHRANE database of systematic reviews were systematically scanned using a defined search strategy to identify relevant articles in this field of research. First selection was done based on abstracts according to specific criteria, where the methodological quality in selected full text articles was assessed by two reviewers. Agreement between raters was investigated using percentage agreement and Cohen's Kappa statistic. The traumatic events were divided into two categories: 1) acute trauma which refers to any single impact situation which directly damages the articular cartilage, and 2) chronic trauma which means cartilage lesions due to overuse or disuse of the shoulder joint.
The agreement on data quality between the two reviewers was 93% with a Kappa value of 0.79 indicating an agreement considered to be 'substantial'. It was found that acute trauma on the shoulder causes humeral articular cartilage to disrupt from the underlying bone. The pathomechanism is said to be due to compression or shearing, which can be caused by a sudden subluxation or dislocation. However, such impact lesions are rarely reported. In the case of chronic trauma glenohumeral cartilage degeneration is a result of overuse and is associated to other shoulder joint pathologies. In these latter cases it is the rotator cuff which is injured first. This can result in instability and consequent impingement which may progress to glenohumeral cartilage damage.
The great majority of glenohumeral cartilage lesions without any bony lesions are the results of overuse. Glenohumeral cartilage lesions with an intact subchondral bone and caused by an acute trauma are either rare or overlooked. And at increased risk for such cartilage lesions are active sportsmen with high shoulder demand or athletes prone to shoulder injury.
应避免肱盂关节出现任何软骨损伤，因为这些损伤可能导致肩部骨关节炎。为了解导致肩部软骨损伤的发病机制，我们对存在软骨下骨无压痕骨折的创伤性关节软骨损伤这一主题进行了系统综述。
使用既定的检索策略对PubMed（MEDLINE）、ScienceDirect（EMBASE、BIOBASE、BIOSIS Previews）和Cochrane系统评价数据库进行系统检索，以识别该研究领域的相关文章。首先根据摘要按照特定标准进行筛选，由两名评审员评估所选全文文章的方法学质量。使用百分比一致性和科恩卡方统计量来研究评分者之间的一致性。创伤事件分为两类：1）急性创伤，指直接损伤关节软骨的任何单次撞击情况；2）慢性创伤，指由于肩关节过度使用或废用导致的软骨损伤。
两名评审员在数据质量上的一致性为93%，卡方值为0.79，表明一致性被认为是“高度一致”。研究发现，肩部急性创伤会导致肱骨关节软骨从下方骨骼分离。其发病机制据说是由于压缩或剪切力，这可能由突然的半脱位或脱位引起。然而，此类撞击损伤很少被报道。在慢性创伤的情况下，肱盂软骨退变是过度使用的结果，并与其他肩关节病变相关。在这些后一种情况下，首先受损的是肩袖。这可能导致不稳定并进而导致撞击，可能发展为肱盂软骨损伤。
绝大多数无任何骨损伤的肱盂软骨损伤是过度使用的结果。软骨下骨完整且由急性创伤引起的肱盂软骨损伤要么罕见，要么被忽视。肩部需求高的活跃运动员或易患肩部损伤的运动员发生此类软骨损伤的风险增加。
