Golijanin Petar, Arner Justin W, Ryan Claire B, Zai Qais, Peebles Liam A, Peebles Annalise M, Ganokroj Phob, Whalen Ryan J, Eble Stephanie K, Rider Danielle, Ninković Srdjan, Provencher Matthew T
Dell Medical School, University of Texas at Austin, Austin, Texas, USA.
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Orthop J Sports Med. 2024 Dec 4;12(12):23259671241297071. doi: 10.1177/23259671241297071. eCollection 2024 Dec.
The concept of on-track versus off-track bone lesions in glenohumeral instability continues to evolve. Although much has been ascertained from an original biomechanical model, bony pathological changes, especially on 3-dimensional (3D) imaging, have not been fully evaluated.
To compare the differences in on-track versus off-track lesions to characterize glenoid and humeral head bone defects using 3D modeling software.
Cross-sectional study; Level of evidence, 3.
A consecutive cohort of 75 patients with recurrent anterior instability, with evidence of Hill-Sachs lesions (HSLs) and glenoid bone loss (GBL) and a mean age of 27.1 years (range, 18-48 years), were reviewed. 3D models of unilateral proximal humeri and glenoids were reconstructed. The volume, surface area, width, and depth of identified HSLs were quantified, along with their location (medial, superior) and orientation (Hill-Sachs angle). The percentage, width, and length of GBL as well as the glenoid track status were calculated. The on-track and off-track groups were compared using the Mann-Whitney test.
The off-track group had greater HSL surface area (374.23 vs 272.64 mm, respectively; = .001), more HSL medialization (14.96 vs 17.62 mm, respectively; = .028), greater HSL volume (603.08 vs 433.61 mm, respectively; = .007), and a greater mean HSL width (16.06 vs 11.53 mm, respectively; = .001) than the on-track group. The off-track group also had greater GBL (22.55% vs 17.73%, respectively; = .037), a greater GBL width (6.92 vs 3.58 mm, respectively; < .001), and a greater GBL length (21.61 vs 16.1mm, respectively; = .015) than the on-track group. Further analysis of large off-track lesions revealed a greater Hill-Sachs angle (33.16° vs 26.20°, respectively; = .035) and a more superior extent of HSLs compared with borderline off-track and on-track lesions.
Off-track lesions were found to have larger GBL, a larger HSL width, a more medialized HSL, and greater HSL surface area. This study outlines the specific characteristics of high-risk bipolar bone loss lesions to simplify the identification of patients in a clinical setting and aid in appropriate treatment planning.
肩关节不稳中轨道内与轨道外骨损伤的概念仍在不断演变。尽管从最初的生物力学模型中已确定了很多内容，但骨病理变化，尤其是三维（3D）成像方面的变化，尚未得到充分评估。
使用3D建模软件比较轨道内与轨道外损伤的差异，以描述肩胛盂和肱骨头骨缺损情况。
横断面研究；证据等级，3级。
回顾了连续纳入的75例复发性前向不稳患者，这些患者有Hill-Sachs损伤（HSLs）和肩胛盂骨丢失（GBL）的证据，平均年龄27.1岁（范围18 - 48岁）。重建了单侧近端肱骨和肩胛盂的3D模型。对识别出的HSLs的体积、表面积、宽度和深度进行量化，同时确定其位置（内侧、上方）和方向（Hill-Sachs角）。计算GBL的百分比、宽度和长度以及肩胛盂轨道状态。使用Mann-Whitney检验比较轨道内和轨道外组。
与轨道内组相比，轨道外组的HSLs表面积更大（分别为374.23 vs 272.64 mm；P = .001），HSLs更向内侧移位（分别为14.96 vs 17.62 mm；P = .028），HSLs体积更大（分别为603.08 vs 433.61 mm；P = .007），平均HSL宽度更大（分别为16.06 vs 11.53 mm；P = .001）。轨道外组的GBL也更大（分别为22.55% vs 17.73%；P = .037），GBL宽度更大（分别为6.92 vs 3.58 mm；P < .001），GBL长度更大（分别为21.61 vs 16.1 mm；P = .015）。对大的轨道外损伤的进一步分析显示，与临界轨道外和轨道内损伤相比，其Hill-Sachs角更大（分别为33.16° vs 26.20°；P = .035），HSLs的上方范围更大。
发现轨道外损伤有更大的GBL、更大的HSL宽度、更向内侧移位的HSLs和更大的HSL表面积。本研究概述了高危双极骨丢失损伤的具体特征，以简化临床环境中患者的识别并有助于进行适当的治疗规划。
