Bryant Jonathan D, Caldwell Paul E, Pearson Sara E
Orthopaedic Research of Virginia, Richmond, Virginia, U.S.A.
Tuckahoe Orthopaedic Associates, Ltd., Richmond, Virginia, U.S.A.
Arthrosc Tech. 2022 Dec 21;12(1):e107-e114. doi: 10.1016/j.eats.2022.08.065. eCollection 2023 Jan.
Osteochondral defects of the shoulder due to posterior instability are less frequent than those caused by anterior instability. Although uncommon, locked posterior dislocations can create sizable osteochondral lesions of the anterior humeral head known as reverse Hill-Sachs lesions. Treatment of these defects to restore the congruent contour of the glenohumeral joint is essential to reduce recurrence of instability and prevent long-term sequelae of arthritis. Historically, nonanatomic options, such as transposition of the subscapularis tendon or lesser tuberosity into the defect and humeral rotational osteotomy, have been endorsed to treat reverse Hill-Sachs lesions. More contemporary techniques have focused on restoring not only the bony architecture but also the chondral surface using fresh osteochondral allografts. The evolution of this approach has been challenging because of the large impacted wedge-shaped defect typically encountered with a locked posterior dislocation. Many surgeons employ techniques using multiple circular grafts or customizing a nonanatomic graft to fill these defects. Given the unstable nature of these grafts, metallic screws are often placed through the chondral surface for fixation. The evolution of the "BioHumi" technique has made treatment of large reverse Hill-Sachs lesions technically simpler and more reproducible using innovative instrumentation to transplant an elliptical osteochondral allograft.
因后方不稳定导致的肩部骨软骨损伤比前方不稳定引起的损伤少见。虽然罕见，但锁定性后方脱位可在前肱骨头产生相当大的骨软骨损伤，即所谓的反向Hill-Sachs损伤。治疗这些损伤以恢复盂肱关节的一致轮廓对于减少不稳定的复发和预防关节炎的长期后遗症至关重要。从历史上看，非解剖学方法，如将肩胛下肌腱或小结节转位至缺损处以及肱骨旋转截骨术，已被认可用于治疗反向Hill-Sachs损伤。更现代的技术不仅专注于恢复骨结构，还使用新鲜骨软骨异体移植物修复软骨表面。由于锁定性后方脱位通常会遇到大的嵌压楔形缺损，这种方法的发展具有挑战性。许多外科医生采用使用多个圆形移植物或定制非解剖学移植物来填充这些缺损的技术。鉴于这些移植物的不稳定性质，通常会通过软骨表面放置金属螺钉进行固定。“BioHumi”技术的发展使得使用创新器械移植椭圆形骨软骨异体移植物治疗大型反向Hill-Sachs损伤在技术上更简单且更可重复。
