Yang Kaijia, Yamamoto Nobuyuki, Takahashi Norimasa, Kamijo Hideki, Okamura Kenji, Mihata Teruhisa, Sugaya Hiroyuki, Funakoshi Tadanao, Atsushi Arino, Kawakami Jun, Aizawa Toshimi, Itoi Eiji
Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
J Shoulder Elbow Surg. 2025 Jan;34(1):88-95. doi: 10.1016/j.jse.2024.03.017. Epub 2024 Apr 19.
In patients with traumatic posterior shoulder instability, little is known about the precise location and size of the reverse Hill-Sachs lesion.
Forty-nine shoulders of 47 patients with traumatic posterior instability were included in this study based on the following inclusion criteria: (1) a primary or recurrent traumatic posterior shoulder dislocation and (2) the initial event being caused by trauma. Patients were excluded if they had (1) no history of trauma, (2) prior shoulder surgery, (3) no computed tomographic (CT) examination, or (4) were seizure cases. Three-dimensional images of the humerus reconstructed from CT images were reviewed using an image analysis software. The location and size of the reverse Hill-Sachs lesion were measured and described on a clock face on the humeral head.
The reverse Hill-Sachs lesion was observed in 25 of 49 shoulders (51%). The reverse Hill-Sachs lesions were located between 1:37 and 2:48. The depth of the reverse Hill-Sachs lesion (mean ± standard deviation) was 5.8 ± 2.2 mm. The extent of the reverse Hill-Sachs lesion was 35° ± 12°. The average orientation of the reverse Hill-Sachs lesion, represented by an angle measured from the 12 o'clock position, was 64° ± 12° and pointing toward 2:09 on a clock face. The mean length and width of reverse Hill-Sachs lesions were 9.7 ± 4.7 mm and 11.1 ± 3.6 mm, respectively.
The reverse Hill-Sachs lesion was a semicircular compression fracture located on the anteromedial aspect of the humeral head. Compared with shoulders with anterior shoulder instability, the humeral defect was smaller and located more inferiorly in shoulders with posterior instability.
在创伤性肩关节后向不稳患者中，关于反Hill-Sachs损伤的确切位置和大小知之甚少。
基于以下纳入标准，本研究纳入了47例创伤性后向不稳患者的49个肩关节：（1）原发性或复发性创伤性肩关节后脱位；（2）初始事件由创伤引起。如果患者有以下情况则被排除：（1）无创伤史；（2）既往肩部手术史；（3）未进行计算机断层扫描（CT）检查；（4）癫痫病例。使用图像分析软件对从CT图像重建的肱骨三维图像进行评估。在肱骨头的钟面上测量并描述反Hill-Sachs损伤的位置和大小。
49个肩关节中有25个（51%）观察到反Hill-Sachs损伤。反Hill-Sachs损伤位于1:37至2:48之间。反Hill-Sachs损伤的深度（平均值±标准差）为5.8±2.2mm。反Hill-Sachs损伤的范围为35°±12°。反Hill-Sachs损伤的平均方向（以从12点位置测量的角度表示）为64°±12°，指向钟面上的2:09。反Hill-Sachs损伤的平均长度和宽度分别为9.7±4.7mm和11.1±3.6mm。
反Hill-Sachs损伤是位于肱骨头前内侧的半圆形压缩骨折。与肩关节前向不稳的患者相比，后向不稳患者的肱骨缺损较小且位置更低。
