Martetschläger Frank, Zampeli Frantzeska, Tauber Mark, Habermeyer Peter
Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany.
Department for Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
JSES Int. 2020 May 7;4(2):318-323. doi: 10.1016/j.jseint.2020.02.011. eCollection 2020 Jun.
The purpose of the study was to investigate which anatomic structures are affected in a series of patients with pulley lesions and whether all lesions can be classified according to the Habermeyer classification.
One hundred consecutive patients with pulley lesions were prospectively studied. During arthroscopy, lesions of the superior glenohumeral ligament (SGHL), medial coracohumeral ligament (MCHL) and/or lateral coracohumeral ligament (LCHL), adjacent rotator cuff, and biceps (long head of the biceps) were recorded. All lesions were then classified according to the Habermeyer classification. The χ test was used for statistical analysis.
There were 3 lesions in group 1, 20 in group 2, 6 in group 3, and 35 in group 4 according to the Habermeyer classification. Thirty-six lesions were not classifiable because of an intact SGHL. A lateral pulley sling (LCHL) lesion was found in 95% of the patients, and a medial pulley sling (MCHL-SGHL) lesion was noted 64%. An isolated lesion of the MCHL and/or SGHL was present in 5%, and an isolated lesion of the LCHL was found in 36%. Combined medial-lateral sling lesions were correlated with complete subscapularis tears and biceps fraying.
The lateral pulley sling is more often affected than the medial sling. The SGHL is not always affected, and isolated lesions of the medial sling are rare. Lesions of both slings correlated with complete subscapularis tears and fraying of the long head of the biceps. An updated classification of direct pulley lesions is proposed: type 1, lesion of the medial pulley (MCHL and/or SGHL); type 2, lesion of the lateral pulley (LCHL); and type 3, lesion of the medial and lateral pulley slings. Concomitant lesions of the indirect pulley stabilizers can be mentioned additionally according to the well-known classifications.
本研究的目的是调查一系列存在滑车损伤的患者中哪些解剖结构受到影响，以及所有损伤是否都能根据哈贝迈尔分类法进行分类。
对连续100例存在滑车损伤的患者进行前瞻性研究。在关节镜检查过程中，记录肩肱上韧带（SGHL）、喙肱中韧带（MCHL）和/或喙肱外侧韧带（LCHL）、相邻的肩袖以及肱二头肌（肱二头肌长头）的损伤情况。然后根据哈贝迈尔分类法对所有损伤进行分类。采用χ检验进行统计分析。
根据哈贝迈尔分类法，1组有3处损伤，2组有20处，3组有6处，4组有35处。由于SGHL完整，36处损伤无法分类。95%的患者发现有外侧滑车吊带（LCHL）损伤，64%的患者发现有内侧滑车吊带（MCHL - SGHL）损伤。MCHL和/或SGHL的孤立损伤占5%，LCHL的孤立损伤占36%。内侧 - 外侧吊带联合损伤与肩胛下肌完全撕裂和肱二头肌磨损相关。
外侧滑车吊带比内侧吊带更常受到影响。SGHL并非总是受到影响，内侧吊带的孤立损伤很少见。双侧吊带损伤与肩胛下肌完全撕裂和肱二头肌长头磨损相关。提出了直接滑车损伤的更新分类：1型，内侧滑车（MCHL和/或SGHL）损伤；2型，外侧滑车（LCHL）损伤；3型，内侧和外侧滑车吊带损伤。可根据已知分类法另外提及间接滑车稳定器的伴随损伤。
