Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
J Orthop Sci. 2023 Nov;28(6):1252-1257. doi: 10.1016/j.jos.2022.09.016. Epub 2022 Oct 22.
It has not been clarified yet how much force is acting on the shoulder joint to create Hill-Sachs/reverse Hill-Sachs lesions which are commonly observed in patients with anterior or posterior shoulder instability. The purpose of this study was to determine the magnitude of force to create these bony lesions using cadaveric shoulders.
Fourteen fresh-frozen cadaveric shoulders were used. Compression tests were performed using the universal testing machine. The specimens were randomly divided into two groups. In group A, the posterior humeral head (the bare area and articular cartilage) was first compressed against the anterior glenoid rim to simulate a Hill-Sachs lesion, followed by the anterior humeral head being compressed against the posterior glenoid rim. In group B, the same procedure was repeated in the reverse order. X-ray microcomputed tomography (microCT) was also performed.
The maximum compression force to create a Hill-Sachs lesion was 771 ± 214 N (mean ± SD) on the articular cartilage of the posterior humeral head, which was significantly greater than the force of 447 ± 215 N to create it on the bare area (P = 0.0086). Regarding the reverse Hill-Sachs lesions, the maximum compression force was 840 ± 198 N when it was created on the articular cartilage of the anterior humeral head, which was significantly greater than the force of 471 ± 100 N when it was created at the footprint of the subscapularis tendon (P = 0.0238). MicroCT showed multiple breakage of the trabecular bone.
A force to create a Hill-Sachs lesion or a reverse Hill-Sachs lesion was significantly greater when it was created on the humeral articular cartilage than at the non-cartilage area. Also, the force to create a reverse Hill-Sachs lesion was significantly greater than the one to create a Hill-Sachs lesion.
目前尚不清楚在肩关节不稳定的患者中常见的 Hill-Sachs/反向 Hill-Sachs 病变是由多大的力引起的。本研究的目的是使用尸体肩关节确定造成这些骨损伤的力的大小。
使用 14 个新鲜冷冻尸体肩关节进行压缩试验。标本随机分为两组。在 A 组中，首先将肱骨头的后表面（裸露区和关节软骨）压向肩胛盂的前边缘，以模拟 Hill-Sachs 病变，然后将肱骨头的前表面压向肩胛盂的后边缘。在 B 组中，以相反的顺序重复相同的操作。还进行了 X 射线微计算机断层扫描（microCT）。
在肱骨头后表面的关节软骨上造成 Hill-Sachs 病变的最大压缩力为 771±214N（平均值±标准差），明显大于在裸露区造成该病变的 447±215N 的力（P=0.0086）。对于反向 Hill-Sachs 病变，在前肱骨头的关节软骨上造成病变的最大压缩力为 840±198N，明显大于在肩胛下肌腱止点处造成病变的 471±100N 的力（P=0.0238）。microCT 显示骨小梁多处断裂。
在肱骨头关节软骨上造成 Hill-Sachs 病变或反向 Hill-Sachs 病变的力明显大于在非软骨区域造成的力。此外，造成反向 Hill-Sachs 病变的力明显大于造成 Hill-Sachs 病变的力。
