Locher Joel, Longo Umile Giuseppe, Pirato Francesco, Susdorf Roman, Henninger Heath B, Suter Thomas
Department of Orthopaedic Surgery, Kantonsspital Baselland, 4101, Bruderholz, Switzerland.
Department of Orthopaedic and Trauma Surgery , Campus Biomedico University , Rome, Italy.
Arch Orthop Trauma Surg. 2023 Jan;143(1):203-211. doi: 10.1007/s00402-021-04016-6. Epub 2021 Jul 5.
The purpose of this study was to determine if "off-track" Hill-Sachs lesions in patients with dynamic anteroinferior instability were transformed into "on-track" lesions using iliac bone autografts with screw fixation. The secondary purpose was to observe if postoperative bony remodeling would occur over time, resulting in recurrent "off-track" Hill-Sachs lesions with corresponding instability.
We retrospectively reviewed clinical and CT records of 8 patients with an "off-track" Hill-Sachs lesion who underwent open anatomical glenoid reconstruction with an iliac crest bone autograft. Hill-Sachs lesions, glenoid track widths, and glenoid surface areas were measured on a preoperative and two postoperative (6 weeks, ≥ 2 years) 3D-CT models to determine graft resorption over time. All patients were available for postoperative clinical and CT final follow-up 3 years (2-4 years) postoperatively.
In all patients, the Hill-Sachs lesions were "on-track" 6 weeks postoperatively and remained "on-track" at final-follow-up. Compared to preoperative values, the glenoid track width and glenoid surface area both were higher 6 weeks postoperatively (p < 0.001 and p = 0.023, respectively) and at final follow-up (p < 0.001 and p = 0.023, respectively). Whereas the glenoid track width between 6 weeks and final follow-up showed no decrease (p = 0.234), glenoid surface area tended to decrease (p = 0.055). The median SSV was 93 points (85-95 points), the Rowe score 90 points (80-100 points) and the WOSI 1980 points (1783-2067 points) at final follow-up. No recurrent dislocations or subluxations were observed.
An open anatomical glenoid reconstruction with an iliac crest bone autograft technique using screw fixation effectively transformed "off-track" Hill-Sachs lesions to "on-track" lesions, resulting in good short-term clinical outcomes. Whereas glenoid surface area tended to be reduced by bony remodeling processes over time, the glenoid track width did not decrease at final follow-up and consequently no recurrence of "off-track" lesions occurred.
Case series; Level of evidence, IV.
本研究的目的是确定使用带螺钉固定的自体髂骨移植，能否将动态下前不稳患者的“脱轨型”希尔-萨克斯损伤转变为“在轨型”损伤。次要目的是观察术后随着时间推移是否会发生骨质重塑，导致复发性“脱轨型”希尔-萨克斯损伤及相应的不稳。
我们回顾性分析了8例接受开放性解剖学盂唇重建及自体髂嵴骨移植的“脱轨型”希尔-萨克斯损伤患者的临床及CT记录。在术前及术后两个时间点（6周、≥2年）的三维CT模型上测量希尔-萨克斯损伤、盂唇轨迹宽度及盂唇表面积，以确定随时间推移的移植物吸收情况。所有患者均在术后3年（2至4年）接受了临床及CT最终随访。
所有患者术后6周时希尔-萨克斯损伤均变为“在轨型”，并在最终随访时保持“在轨型”。与术前值相比，术后6周时盂唇轨迹宽度及盂唇表面积均增加（分别为p<0.001和p=0.023），最终随访时亦如此（分别为p<0.001和p=0.023）。虽然6周与最终随访之间的盂唇轨迹宽度没有减小（p=0.234），但盂唇表面积有减小趋势（p=0.055）。最终随访时，平均SSV为93分（85至95分），Rowe评分为90分（80至100分），WOSI为1980分（1783至2067分）。未观察到复发性脱位或半脱位。
采用带螺钉固定的自体髂嵴骨移植技术进行开放性解剖学盂唇重建，可有效将“脱轨型”希尔-萨克斯损伤转变为“在轨型”损伤，获得良好的短期临床效果。虽然随着时间推移，骨质重塑过程会使盂唇表面积有减小趋势，但最终随访时盂唇轨迹宽度未减小，因此未出现“脱轨型”损伤复发。
病例系列；证据水平，IV级。
