Hospital for Special Surgery.
Weill Cornell Medical College, New York, NY.
J Pediatr Orthop. 2022 Feb 1;42(2):e143-e148. doi: 10.1097/BPO.0000000000002017.
The sequential maturation of the humeral head (HH) as viewed on magnetic resonance imaging (MRI) has not been described to date. Proper assessment may be complicated by the presence of physeal tissue in pediatric patients. Past studies suggest that skeletally immature patients may also have a higher risk of a false-positive diagnosis of Hill-Sachs lesion on MRI. The purpose of this study was to define pediatric HH developmental patterns using MRI and to investigate for any associations with findings of known false-positive Hill-Sachs.
Picture Archiving and Communication System (PACS) records at an urban academic tertiary care musculoskeletal facility from 2014 to 2020 were queried for shoulder MRI in patients aged 0 to 15 years. Patients were excluded if they had a history of glenohumeral instability, fracture, growth arrest, brachial plexus injury, surgery, or infection. All images were independently evaluated by a musculoskeletal fellowship-trained radiologist. Each HH was staged based on skeletal maturity.
For both sexes, HHs matured in a predictable manner with increasing chronological age associated with a higher ossification stage. False Hill-Sachs lesions were observed in girls aged 4 to 7 and boys aged 5 to 14, exclusively during stage I to II ossification.
False Hill-Sachs lesions were visualized on MRI in stage I to II proximal humerus ossification. Due to differential timing of skeletal maturation, males present with false Hill-Sachs lesions at a later age than females on average. When interpreting shoulder MRI for glenohumeral instability, clinicians should be cautious of false Hill-Sachs lesions, especially in younger patients with distinct greater tuberosity and HH ossification centers (stage I to II ossification).
Level III.
迄今为止，尚未对磁共振成像（MRI）上观察到的肱骨头（HH）的顺序成熟进行描述。在儿科患者中存在骺软骨组织，可能会使适当的评估变得复杂。过去的研究表明，骺软骨未闭的患者也可能有更高的假阳性 Hill-Sachs 损伤 MRI 诊断风险。本研究的目的是使用 MRI 定义小儿 HH 的发育模式，并研究与已知假阳性 Hill-Sachs 发现的任何关联。
2014 年至 2020 年，在城市学术三级护理肌肉骨骼设施的图像存档与通信系统（PACS）记录中，对 0 至 15 岁患者的肩部 MRI 进行了查询。如果患者有肩盂肱关节不稳定、骨折、生长停滞、臂丛神经损伤、手术或感染史，则将其排除在外。所有图像均由一位经过肌肉骨骼专业培训的放射科医生独立评估。每个 HH 根据骨骼成熟度进行分期。
对于男女两性，HH 的成熟方式具有可预测性，与较高的骨化阶段相关的年龄增加。假 Hill-Sachs 病变仅在 I 期至 II 期骨化期间观察到，在 4 至 7 岁女孩和 5 至 14 岁男孩中。
在 I 期至 II 期肱骨近端骨化期间，在 MRI 上可以看到假 Hill-Sachs 病变。由于骨骼成熟的时间不同，男性的假 Hill-Sachs 病变比女性平均晚出现。在对盂肱关节不稳定的肩部 MRI 进行解释时，临床医生应警惕假 Hill-Sachs 病变，尤其是在具有明显大结节和 HH 骨化中心（I 期至 II 期骨化）的年轻患者中。
III 级。
