Nakagawa Shigeto, Sahara Wataru, Kinugasa Kazutaka, Uchida Ryohei, Mae Tatsuo
Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan.
Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Japan.
Orthop J Sports Med. 2021 May 13;9(5):23259671211003553. doi: 10.1177/23259671211003553. eCollection 2021 May.
In shoulders with traumatic anterior instability, a bipolar bone defect has been recognized as an important indicator of the prognosis.
To investigate bipolar bone defects at primary instability and compare the difference between dislocation and subluxation.
Cohort study; Level of evidence, 3.
There were 156 shoulders (156 patients) including 91 shoulders with dislocation and 65 shoulders with subluxation. Glenoid defects and Hill-Sachs lesions were classified into 5 size categories on 3-dimensional computed tomography (CT) scans and were allocated scores ranging from 0 (no defect) to 4 points (very large defect). To assess the combined size of the glenoid defect and Hill-Sachs lesion, the scores for both lesions were summed (range, 0-8 points). Patients in the dislocation and subluxation groups were compared regarding the prevalence of a glenoid defect, a bone fragment of bony Bankart lesion, a Hill-Sachs lesion, a bipolar bone defect, and an off-track Hill-Sachs lesion. Then, the combined size of the bipolar bone defects was compared between the dislocation and subluxation groups and among patients stratified by age at the time of CT scanning (<20, 20-29, and ≥30 years).
Hill-Sachs lesions were observed more frequently in the dislocation group (75.8%) compared with the subluxation group (27.7%; < .001), whereas the prevalence of glenoid defects was not significantly different between groups (36.3% vs 29.2%, respectively; = .393). The combined defect size was significantly larger in the dislocation versus subluxation group (mean ± SD combined defect score, 2.1 ± 1.6 vs 0.8 ± 0.9 points, respectively; < .001) due to a larger Hill-Sachs lesion at dislocation than subluxation (glenoid defect score, 0.5 ± 0.9 vs 0.3 ± 0.6 points [ = .112]; Hill-Sachs lesion score, 1.6 ± 1.2 vs 0.4 ± 0.7 points [ < .001]). Combined defect size was larger in older patients than younger patients in the setting of dislocation (combined defect score, <20 years, 1.6 ± 1.2 points; 20-29 years, 1.9 ± 1.5 points; ≥30 years, 3.4 ± 1.6 points; < .001) but was not different in the setting of subluxation (0.8 ± 1.0, 0.7 ± 0.9, and 0.8 ± 0.8 points, respectively; = .885). An off-track Hill-Sachs lesion was observed in 2 older patients with dislocation but was not observed in shoulders with subluxation.
The bipolar bone defect was significantly more frequent, and the combined size was greater in shoulders with primary dislocation and in older patients (≥30 years).
在创伤性前向不稳的肩部，双极骨缺损已被认为是预后的重要指标。
研究初次不稳时的双极骨缺损，并比较脱位与半脱位之间的差异。
队列研究；证据等级，3级。
共纳入156例肩部病例（156例患者），其中91例为脱位肩部，65例为半脱位肩部。在三维计算机断层扫描（CT）上，将肩胛盂缺损和希尔-萨克斯损伤分为5个大小类别，并赋予0分（无缺损）至4分（非常大缺损）的评分。为评估肩胛盂缺损和希尔-萨克斯损伤的联合大小，将两者的评分相加（范围为0 - 8分）。比较脱位组和半脱位组患者肩胛盂缺损、骨性Bankart损伤的骨块、希尔-萨克斯损伤、双极骨缺损及脱轨性希尔-萨克斯损伤的发生率。然后，比较脱位组和半脱位组之间以及根据CT扫描时年龄分层的患者（<20岁、20 - 29岁和≥30岁）之间双极骨缺损的联合大小。
与半脱位组（27.7%）相比，脱位组（75.8%）更常观察到希尔-萨克斯损伤（P <.001），而两组之间肩胛盂缺损的发生率无显著差异（分别为36.3%和29.2%；P = 0.393）。由于脱位时的希尔-萨克斯损伤比半脱位时更大，脱位组的联合缺损大小显著大于半脱位组（联合缺损评分的均值±标准差分别为2.1±1.6分和0.8±0.9分；P <.001）（肩胛盂缺损评分，0.5±0.9分对0.3±0.6分[P = 0.112]；希尔-萨克斯损伤评分，1.6±1.2分对0.4±0.7分[P <.001]）。在脱位情况下，老年患者的联合缺损大小大于年轻患者（联合缺损评分，<20岁为1.6±1.2分；20 - 29岁为1.9±1.5分；≥30岁为3.4±1.6分；P <.001），但在半脱位情况下无差异（分别为0.8±1.0分、0.7±0.9分和0.8±0.8分；P = 0.885）。在2例老年脱位患者中观察到脱轨性希尔-萨克斯损伤，而在半脱位肩部未观察到。
初次脱位的肩部及老年患者（≥30岁）中，双极骨缺损明显更常见，且联合大小更大。
