Nakagawa Shigeto, Hirose Takehito, Uchida Ryohei, Nakamura Hiroyuki, Mae Tatsuo, Hayashida Kenji, Yoneda Minoru
Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Osaka, Japan.
Department of Orthopaedic Surgery, Daini Osaka Police Hospital, Osaka, Osaka, Japan.
JSES Int. 2022 Dec 21;7(2):218-224. doi: 10.1016/j.jseint.2022.12.010. eCollection 2023 Mar.
With recurrent anterior instability the bone fragment of a bony Bankart lesion is often small compared to the glenoid defect. The purpose of the present study was to clarify the changes to both the bone fragment and glenoid defect over time in a single subject.
Participants were patients who underwent computed tomography (CT) at least twice after an instability event between 2004 and 2021 and had a fragment-type glenoid at first CT. The glenoid rim width (), glenoid defect width (), and bone fragment width () were measured in millimeters. If or increased by 1 mm or more from the first to final CT, the change was judged as "enlarged," and if or decreased by 1 mm or more, it was judged as "reduced"; all other cases were judged as "similar." Then, glenoid defect size and bone fragment size were calculated as ×100% and ×100%, respectively, and the changes from the first to final CT were compared.
From the first to final CT, the glenoid defect was enlarged in 30 shoulders, similar in 13 shoulders, and reduced in 4 shoulders, and the bone fragment was enlarged in 18 shoulders, similar in 24 shoulders, and reduced in 5 shoulders. The mean glenoid defect size significantly increased from 10.9% to 15.3% ( < .001), and the mean bone fragment size increased from 6.4% to 7.8%, respectively ( = .005). At the final CT, in 6 shoulders a new glenoid fracture was observed at a different site from the original fracture. When they were excluded from the analyses, the mean glenoid defect size still significantly increased (from 11.2% to 15.2%; < .001), but the mean bone fragment size did not (6.5% vs. 7.3%, respectively; = .088).
In shoulders with recurrent anterior instability, glenoid defect size appears to increase significantly over time, whereas the bone fragment size remains unchanged or increases only slightly. Bone fragment resorption is quite rare, and a bone fragment appears to be small because of an enlarged glenoid defect.
对于复发性前向不稳定，与肩胛盂缺损相比，骨性Bankart损伤的骨块通常较小。本研究的目的是阐明单一受试者中骨块和肩胛盂缺损随时间的变化。
研究对象为2004年至2021年间不稳定事件后至少接受两次计算机断层扫描（CT）且首次CT显示为碎片型肩胛盂的患者。肩胛盂边缘宽度（）、肩胛盂缺损宽度（）和骨块宽度（）以毫米为单位进行测量。如果从首次CT到末次CT，或增加1毫米或更多，则变化判定为“增大”；如果或减少1毫米或更多，则判定为“缩小”；所有其他情况判定为“相似”。然后，分别计算肩胛盂缺损大小和骨块大小为×100%和×100%，并比较从首次CT到末次CT的变化。
从首次CT到末次CT，肩胛盂缺损增大的有30例，相似的有13例，缩小的有4例；骨块增大的有18例，相似的有24例，缩小的有5例。肩胛盂缺损平均大小从10.9%显著增加到15.3%（<0.001），骨块平均大小分别从6.4%增加到7.8%（=0.005）。在末次CT时，6例患者在与原骨折不同的部位观察到新的肩胛盂骨折。当将这些病例排除在分析之外时，肩胛盂缺损平均大小仍显著增加（从11.2%增加到15.2%；<0.001），但骨块平均大小未增加（分别为6.5%和7.3%；=0.088）。
在复发性前向不稳定的肩部，肩胛盂缺损大小似乎随时间显著增加，而骨块大小保持不变或仅略有增加。骨块吸收非常罕见，骨块看起来小是因为肩胛盂缺损增大。
