Tohoku University, Tohoku Rosai Hospital.
Arthroscopy. 2021 Nov;37(11):3262-3265. doi: 10.1016/j.arthro.2021.07.011.
The risk of a Hill-Sachs lesion (HSL) to engage the anterior glenoid rim depends on the location of the medial margin of the HSL relative to the anterior rim of the glenoid. The same-sized HSL can be engaging or nonengaging depending upon the size of the glenoid. In order to assess these bony lesions (bipolar lesion) together, the glenoid track concept has been introduced: an on-track lesion (stable) and an off-track lesion (unstable). Three-dimensional computed tomography (3D-CT) confirms that more medialized HSLs have larger volume, greater width, more surface area loss, and higher lesion angles (HS angle), and are more inferior in the humeral head. We know that medialization of the HSL is a definitive risk factor to make it off track, whereas the volume, surface area, and width are all subordinate risk factors dependent on the medialization. On the other hand, while we know very little about the orientation of the HSL, recent research shows a significant association between the medialization and orientation of the HSL. However, we do not know whether the orientation is an independent risk factor or dependent on the medialization. There are two things I emphasize when I look at a HSL: 1) do not look at the HSL alone, but look at the glenoid as well, and 2) the risk of the HSL depends on the location of the medial margin of the HSL relative to the glenoid, not on the volume, depth, or length.
Hill-Sachs 损伤（HSL）与前关节盂缘接触的风险取决于 HSL 内侧缘相对于关节盂前缘的位置。同样大小的 HSL 可能与关节盂接触或不接触，这取决于关节盂的大小。为了一起评估这些骨损伤（双极损伤），引入了关节盂轨迹概念：在轨迹内的损伤（稳定）和在轨迹外的损伤（不稳定）。三维 CT（3D-CT）证实，更向内侧的 HSL 具有更大的体积、更宽的宽度、更大的表面积损失和更高的损伤角度（HS 角），并且在肱骨头中更低。我们知道 HSL 的内侧化是使其脱离轨迹的明确危险因素，而体积、表面积和宽度都是依赖于内侧化的次要危险因素。另一方面，虽然我们对 HSL 的方向知之甚少，但最近的研究表明 HSL 的内侧化和方向之间存在显著关联。然而，我们不知道方向是否是一个独立的危险因素，还是依赖于内侧化。当我观察 HSL 时，有两件事我强调：1）不要单独观察 HSL，还要观察关节盂，2）HSL 的风险取决于 HSL 内侧缘相对于关节盂的位置，而不是体积、深度或长度。
