Ozaki Ritsuro, Nakagawa Shigeto, Mizuno Naoko, Mae Tatsuo, Yoneda Minoru
Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Osaka, Japan.
Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
Am J Sports Med. 2014 Nov;42(11):2597-605. doi: 10.1177/0363546514549543. Epub 2014 Sep 17.
In patients with traumatic anterior shoulder instability, a large Hill-Sachs lesion is a risk factor for postoperative recurrence. However, there is no consensus regarding the occurrence and enlargement of Hill-Sachs lesions.
To investigate the influence of the number of dislocations and subluxations on the prevalence and size of Hill-Sachs lesions evaluated by computed tomography (CT) with 3-dimensional reconstruction.
Cohort study (diagnosis); Level of evidence, 2.
The prevalence and size of Hill-Sachs lesions were evaluated preoperatively by CT in 142 shoulders (30 with primary instability and 112 with recurrent instability) before arthroscopic Bankart repair. First, the prevalence of Hill-Sachs lesions was compared with the arthroscopic findings. Then, the size of Hill-Sachs lesions confirmed by arthroscopy was remeasured using the previous CT data. In addition, the relationship of Hill-Sachs lesions with the number of dislocations and subluxations was investigated.
Hill-Sachs lesions were detected in 90 shoulders by initial CT evaluation and were found in 118 shoulders at arthroscopy. The Hill-Sachs lesions missed by initial CT were 15 chondral lesions and 13 osseous lesions. However, all 103 osseous Hill-Sachs lesions were detected by reviewing the CT data. In patients with primary subluxation, the prevalence of Hill-Sachs lesions was 26.7%, and the mean length, width, and depth of the lesions (calculated as a percentage of the diameter of the humeral head) were 9.0%, 5.3%, and 2.1%, respectively, while the corresponding numbers for primary dislocation were 73.3%, 27.7%, 14.8%, and 7.0%, all showing statistically significant differences. Among all 142 shoulders, the corresponding numbers were, respectively, 56.3%, 20.7%, 11.2%, and 4.8% in patients who had subluxations but never a dislocation; 83.3%, 33.4%, 19.1%, and 7.6% in patients with 1 episode of dislocation; and 87.5%, 46.8%, 22.2%, and 10.2% in patients with ≥2 episodes, all showing statistically significant differences. There were no differences in lesion measurements in relation to the number of subluxations.
Computed tomography is a useful imaging modality for evaluating Hill-Sachs lesions except for purely cartilaginous lesions. Hill-Sachs lesions were more frequent and larger when the primary episode was dislocation than when it was subluxation. Among patients with recurrent episodes of complete dislocation, the prevalence of Hill-Sachs lesions is increased, and the lesions are larger.
在创伤性前肩不稳患者中，巨大的希尔-萨克斯损伤是术后复发的危险因素。然而，关于希尔-萨克斯损伤的发生和扩大尚无共识。
通过三维重建计算机断层扫描（CT）研究脱位和半脱位次数对希尔-萨克斯损伤的发生率和大小的影响。
队列研究（诊断）；证据等级，2级。
在关节镜下Bankart修复术前，对142例肩部（30例初次不稳和112例复发性不稳）进行CT检查，评估希尔-萨克斯损伤的发生率和大小。首先，将希尔-萨克斯损伤的发生率与关节镜检查结果进行比较。然后，使用先前的CT数据重新测量经关节镜证实的希尔-萨克斯损伤的大小。此外，研究希尔-萨克斯损伤与脱位和半脱位次数的关系。
初次CT评估在90例肩部发现希尔-萨克斯损伤，关节镜检查在118例肩部发现该损伤。初次CT漏诊的希尔-萨克斯损伤有15例软骨损伤和13例骨损伤。然而，通过复查CT数据，所有103例骨希尔-萨克斯损伤均被检测到。在初次半脱位患者中，希尔-萨克斯损伤的发生率为26.7%，损伤的平均长度、宽度和深度（以肱骨头直径的百分比计算）分别为9.0%、5.3%和2.1%，而初次脱位患者的相应数字分别为73.3%、27.7%、14.8%和7.0%，均显示出统计学显著差异。在所有142例肩部中，有半脱位但从未脱位的患者的相应数字分别为56.3%、20.7%、11.2%和4.8%；有1次脱位发作的患者为83.3%、33.4%、19.1%和7.6%；有≥2次发作的患者为87.5%、46.8%、22.2%和10.2%，均显示出统计学显著差异。损伤测量与半脱位次数无关。
计算机断层扫描是评估希尔-萨克斯损伤的有用影像学方法，但不包括单纯软骨损伤。当初次发作是脱位时，希尔-萨克斯损伤比半脱位时更频繁且更大。在复发性完全脱位患者中，希尔-萨克斯损伤的发生率增加，且损伤更大。
