Radiology Department, University of Missouri, Columbia, MO, USA.
Statistics Department, University of Missouri, Columbia, MO, USA.
Skeletal Radiol. 2021 Sep;50(9):1889-1897. doi: 10.1007/s00256-021-03763-2. Epub 2021 Mar 25.
To investigate factors which affect radiographic diagnosis of Hill-Sachs fractures, and find criteria which improve detection.
Retrospective search was made for the term "Hill Sachs" within MRI reports in our local PACS system, and cases with post-reduction radiographs were included in the study. Prospective diagnoses and subspecialty MSK training of the interpreting radiologist of record were recorded. Images were then retrospectively reviewed by two observers and statistical analysis was performed.
Our retrospective study included 181 cases, of which 35% had prospective radiographic diagnosis of Hill-Sachs fracture. Retrospective review found that 73% of the radiograph series had at least 1 sign of a Hill-Sachs fracture. The internal rotation view showed a Hill-Sachs lesion in 59% of cases, but did not detect it in 14% of cases, where the lesion was instead visible on axillary, external rotation, and/or scapular Y view. Odds ratio of prospective Hill-Sachs detection on radiographs was 2.68 for musculoskeletal fellowship-trained radiologists versus non-musculoskeletal-trained radiologists.
Hill-Sachs fractures are often not recognized on post-reduction radiographs. Diagnosis of Hill-Sachs lesion can be significantly increased if radiologists are aware that the internal rotation view may fail to show the injury, and if all 4 views of a shoulder series are scrutinized.
研究影响 Hill-Sachs 骨折放射诊断的因素，并寻找提高检出率的标准。
在我们本地的 PACS 系统中，对 MRI 报告中的“Hill Sachs”一词进行了回顾性搜索，并将有术后 X 线片的病例纳入研究。记录了记录放射科医生的前瞻性诊断和骨科专业培训情况。然后，由两名观察者对图像进行回顾性审查，并进行统计学分析。
我们的回顾性研究包括 181 例病例，其中 35%的病例有前瞻性的 Hill-Sachs 骨折放射诊断。回顾性复查发现，73%的 X 线系列至少有 1 个 Hill-Sachs 骨折的征象。内旋位片显示 59%的病例有 Hill-Sachs 病变，但有 14%的病例在腋位、外旋位和/或肩胛 Y 位可见病变。在放射科医生中，肌肉骨骼专业奖学金培训的放射科医生对 Hill-Sachs 骨折的前瞻性检出率的比值比为 2.68，而非肌肉骨骼专业培训的放射科医生。
Hill-Sachs 骨折在术后 X 线片上常未被识别。如果放射科医生知道内旋位片可能无法显示损伤，如果仔细检查肩 X 线片的所有 4 个视图，则可以显著提高 Hill-Sachs 病变的诊断率。
