Valencia Mora Maria, Ruiz-Ibán Miguel Ángel, Heredia Jorge Diaz, Ruiz Díaz Raquel, Cuéllar Ricardo
Hospital Fundación Jiménez Diáz, Madrid, Spain.
Hospital Universitario Ramón y Cajal; Madrid, Spain.
Open Orthop J. 2017 Aug 31;11:1011-1022. doi: 10.2174/1874325001711011011. eCollection 2017.
A Hill Sachs lesion is a posterior-superior bony defect of the humeral head caused by a compression of the hard glenoid rim against the soft cancellous bone in the context of an anterior instability episode. The presence of these humeral defects increases with the number of dislocations and larger lesions are associated with a greater chance of development of recurrent instability and recurrence after surgery. Also its location and pattern, in particular the so-called engaging Hill-Sachs, are associated with poor prognosis.
There is a lack of consensus in terms of classification and management algorithm, although lesions greater than 25% of the humeral head had been suggested to need more than a simple Bankart repair to avoid recurrence. The concept of glenoid track has turned the attention to location and shape and not only size of the humeral defect. Moreover, the glenoid bone loss is crucial when choosing a treatment option as it contributes to decrease the glenoid track as well. A thorough revision of treatment options has been performed.
Numerous treatment options have been proposed including remplissage, glenoid or humeral head augmentation, bone desimpaction, humeral rotational osteotomy and arthroplasty.
Humeral defects treatment should be individualized. Determination of size and location of the defect and its relation with glenoid track is mandatory to achieve satisfactory results.
希尔-萨克斯损伤是肱骨头后上方的骨质缺损，由前向不稳发作时坚硬的肩胛盂边缘挤压松软的松质骨所致。这些肱骨缺损的出现随脱位次数增加而增多，较大的损伤与复发性不稳及术后复发的可能性增大相关。其位置和形态，尤其是所谓的嵌顿性希尔-萨克斯损伤，与预后不良相关。
在分类和治疗方案方面缺乏共识，尽管有人提出，当肱骨头上的损伤超过25%时，需要进行比单纯的Bankart修复更复杂的手术以避免复发。肩胛盂轨迹的概念将关注点转向了肱骨缺损的位置、形状，而不仅仅是大小。此外，在选择治疗方案时，肩胛盂骨质流失至关重要，因为它也会导致肩胛盂轨迹减小。已对治疗方案进行了全面修订。
已提出多种治疗方案，包括充填术、肩胛盂或肱骨头增大术、骨质撞击术、肱骨旋转截骨术和关节成形术。
肱骨缺损的治疗应个体化。必须确定缺损的大小和位置及其与肩胛盂轨迹的关系，以取得满意的效果。
