Ohlmeier Malte, Schlichter Adrian, Stange Richard
Department of Orthopaedic and Trauma Surgery, UKM Marienhospital, Steinfurt, Germany.
Department of Regenerative Musculoskeletal Medicine, Institute of Musculoskeletal Medicine (IMM), University Hospital Münster, Münster, Germany.
Arthrosc Tech. 2024 Sep 12;14(2):103235. doi: 10.1016/j.eats.2024.103235. eCollection 2025 Feb.
Large Hill-Sachs lesions (HSL) are currently treated via a remplissage procedure. Although the good stabilizing properties of this surgery are apparent, there are some disadvantages in terms of the functional outcome. In the following Technical Note, we present a method of arthroscopic-controlled reduction of HSL for anatomical restoration of the humeral head without functional limitations. For HSL reduction, we place a 1.6-mm K-wire in the central lesion under arthroscopic and fluoroscopic control from posterior to anterior in lateral drilling direction. Then, a 7-mm cannulated drill is used for preparing the reduction canal. Afterward, the HSL is reduced via bone tamp, also under arthroscopic and fluoroscopic control. No bone substitution material is used to fill the canal; only a standard wound closure is performed. Arthroscopic-controlled reduction of impacted humeral head fractures seems to be a possible and relatively easy way to perform an anatomical restoration of HSLs. Because the exact location of HSLs can vary slightly, the exact surgical setting might be slightly different each time. Biomechanical studies already show similar stabilizing properties of this procedure compared with established techniques but without losing external rotation. Further studies need to review the potential rate of humeral head necrosis or secondary loss of reduction.
大型希尔-萨克斯损伤（HSL）目前通过充填手术进行治疗。尽管该手术良好的稳定特性显而易见，但在功能结果方面仍存在一些缺点。在以下技术说明中，我们介绍一种关节镜控制下复位HSL的方法，以实现肱骨头的解剖复位且无功能限制。对于HSL复位，我们在关节镜和透视控制下，从后侧到前侧沿外侧钻孔方向在中央损伤处置入一根1.6毫米的克氏针。然后，使用7毫米的空心钻制备复位通道。之后，同样在关节镜和透视控制下，通过骨锤对HSL进行复位。不使用骨替代材料填充通道；仅进行标准的伤口缝合。关节镜控制下复位嵌插型肱骨头骨折似乎是一种可行且相对简单的实现HSL解剖复位的方法。由于HSL的确切位置可能略有不同，每次的确切手术设置可能会稍有差异。生物力学研究已经表明，与现有技术相比，该手术具有相似的稳定特性，但不会丧失外旋功能。进一步的研究需要评估肱骨头坏死或继发性复位丢失的潜在发生率。
