Matsumura Noboru, Oki Satoshi, Kitashiro Masateru, Minemoto Mayu, Ichikawa Takeru, Matsumoto Morio, Nakamura Masaya, Nagura Takeo
Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
J Shoulder Elbow Surg. 2017 Sep;26(9):1662-1669. doi: 10.1016/j.jse.2017.03.009. Epub 2017 May 3.
Although bone defects of the humeral head and glenoid could affect glenohumeral instability, bone loss has not been sufficiently evaluated. The purpose of this study was to quantify bone defects 3-dimensionally in cases with glenohumeral instability.
Three-dimensional surface models of bilateral proximal humeri and glenoids were reconstructed from computed tomography scans of 90 patients with symptomatic, unilateral, recurrent glenohumeral instability. The left-side models were mirrored, and intact bone areas were matched to those of the right-side models. The volume, length, width, and depth of identified bone defects were assessed. After the values were corrected by patient height, the characteristics of the bone defects were evaluated.
Bone defects were present in 97.8% of the humeral heads and 96.7% of the glenoids, and women had significantly smaller bone defects than men did. The volume of humeral head defects had a mild correlation with that of glenoid defects. The number of traumatic episodes was not correlated with humeral head bone defects, but it was positively correlated with glenoid bone defects. Patients with recurrent dislocations had significantly deeper and larger Hill-Sachs lesions than the other cases.
Bone defects of the humeral head and the glenoid in cases with symptomatic traumatic glenohumeral instability were quantified 3-dimensionally using a computed tomography surface-matching technique. Almost all cases showed bone defects in the humeral head and glenoid compared with the intact shoulder, and such bone defects may be more common than previously reported. This study suggested that bipolar bone lesions are not always created by the same mechanism.
尽管肱骨头和肩胛盂的骨缺损会影响盂肱关节的稳定性，但骨量丢失尚未得到充分评估。本研究的目的是对盂肱关节不稳定病例的骨缺损进行三维定量分析。
对90例有症状的单侧复发性盂肱关节不稳定患者的计算机断层扫描图像进行重建，构建双侧近端肱骨和肩胛盂的三维表面模型。将左侧模型镜像，使完整骨区域与右侧模型匹配。评估识别出的骨缺损的体积、长度、宽度和深度。在根据患者身高对数值进行校正后，评估骨缺损的特征。
97.8%的肱骨头和96.7%的肩胛盂存在骨缺损，女性的骨缺损明显小于男性。肱骨头缺损体积与肩胛盂缺损体积呈轻度相关性。创伤发作次数与肱骨头骨缺损无关，但与肩胛盂骨缺损呈正相关。复发性脱位患者的Hill-Sachs损伤比其他病例明显更深、更大。
采用计算机断层扫描表面匹配技术对有症状的创伤性盂肱关节不稳定病例的肱骨头和肩胛盂骨缺损进行了三维定量分析。与正常肩关节相比，几乎所有病例的肱骨头和肩胛盂均显示有骨缺损，且这种骨缺损可能比先前报道的更为常见。本研究表明，双侧骨损伤并非总是由相同机制造成。
