Zehnder Philipp, Kersten Max, Schwarz Markus, Biberthaler Peter, Kirchhoff Chlodwig, Willinger Lukas
Department of Trauma Surgery, Technical University Munich, Germany.
Department of Sport Orthopaedics, Technical University Munich, Munich, Germany.
JSES Int. 2024 Nov 17;9(2):350-354. doi: 10.1016/j.jseint.2024.10.011. eCollection 2025 Mar.
Anterior shoulder dislocation is a prevalent clinical issue, with high recurrence rates after initial dislocation. Stability of the shoulder joint is maintained by the interplay of static and dynamic stabilizers, including the glenoid and humeral head morphology. Glenoid morphology has been identified as particularly influential in joint stability, and thus the evaluation of glenoid bone loss is crucial in managing shoulder dislocations. This study aimed to investigate the differences in glenoid morphologies between on-track and off-track lesions postdislocation.
This retrospective case-control study included patients who presented with shoulder dislocation at a level 1 trauma center from 2011 to 2020. Patients with anterior shoulder dislocation, complete computed tomography imaging, visible bone loss, and those aged 18 years or more were included. Radiographic parameters were assessed using a certified picture achieving and communication system workstation. The groups were divided into on-track or off-track lesions and their glenoid version, glenoid concavity, and the morphometrical-based bony shoulder stability ratio (BSSR) were compared.
Two hundred twelve patients (70% male and mean age of 50 years) were included and no significant difference was found between the on-track and off-track groups in terms of demographics or injury mechanism. Significant differences were noted in the glenoid defect (1.28 mm vs. 4.67 mm, = .001), glenoid concavity/depth (1.7 mm vs. 1.3 mm, = .001), the BSSR (40% vs. 33%, = .001), and glenoid retroversion (4.4 vs. 2.9°, = .009).
Glenoid morphology has become an increasing focus in the treatment of anterior shoulder dislocation. Patients with an off-track lesion appear to have not only greater glenoid loss and a larger Hill-Sachs but also a flatter glenoid with less retroversion. This also appears to lead to a lower BSSR.
肩关节前脱位是一个常见的临床问题，初次脱位后复发率较高。肩关节的稳定性由静态和动态稳定器的相互作用维持，包括关节盂和肱骨头的形态。关节盂形态已被确定对关节稳定性有特别重要的影响，因此评估关节盂骨缺损在处理肩关节脱位中至关重要。本研究旨在调查脱位后轨道内和轨道外损伤的关节盂形态差异。
这项回顾性病例对照研究纳入了2011年至2020年在一级创伤中心出现肩关节脱位的患者。纳入肩关节前脱位、有完整计算机断层扫描成像、可见骨缺损且年龄在18岁及以上的患者。使用经认证的图像采集和通信系统工作站评估影像学参数。将这些组分为轨道内或轨道外损伤，并比较它们的关节盂版本、关节盂凹陷和基于形态测量的骨性肩部稳定率（BSSR）。
纳入了212例患者（70%为男性，平均年龄50岁），轨道内和轨道外组在人口统计学或损伤机制方面未发现显著差异。在关节盂缺损（1.28毫米对4.67毫米，P = .001）、关节盂凹陷/深度（1.7毫米对1.3毫米，P = .001）、BSSR（40%对33%，P = .001）和关节盂后倾（4.4对2.9°，P = .009）方面发现了显著差异。
关节盂形态在肩关节前脱位的治疗中越来越受到关注。轨道外损伤的患者似乎不仅有更大的关节盂缺损和更大的希尔-萨克斯损伤，而且关节盂更扁平，后倾更小。这似乎也导致了更低的BSSR。
