Bollier Matthew J, Arciero Robert
Department of Orthopaedic Surgery, University of Iowa, Iowa City, IA 52242, USA.
Sports Med Arthrosc Rev. 2010 Sep;18(3):140-8. doi: 10.1097/JSA.0b013e3181e88ef9.
Glenoid and humeral head bone deficiency is a common reason for recurrent anterior shoulder instability and failure of capsulolabral reconstruction. There is a strong association between the severity of the bone defects and the number and ease of recurrent instability. Clinical evaluation, advanced imaging, examination under anesthesia, and diagnostic arthroscopy are important in decision making. Glenoid bone loss greater than 20%, an engaging Hill-Sachs lesion, or Instability Severity Index Score greater than 6 are indications for an open bony procedure to restore the glenoid articular arc. Hill-Sachs lesions greater than 30% should be directly addressed with either an arthroscopic remplissage technique or open bone grafting procedure.
肩胛盂和肱骨头骨质缺损是复发性肩关节前脱位和关节囊盂唇重建失败的常见原因。骨缺损的严重程度与复发性脱位的次数和易发性之间存在密切关联。临床评估、高级影像学检查、麻醉下检查和诊断性关节镜检查对决策很重要。肩胛盂骨丢失大于20%、明显的Hill-Sachs损伤或不稳定严重程度指数评分大于6是进行开放性骨手术以恢复肩胛盂关节面弧度的指征。Hill-Sachs损伤大于30%应采用关节镜下充填技术或开放性植骨手术直接处理。
