Wintzell G, Haglund-Akerlind Y, Tengvar M, Johansson L, Eriksson E
Department of Orthopaedic Surgery, Söder Hospital, Stockholm, Sweden.
Knee Surg Sports Traumatol Arthrosc. 1996;4(4):232-6. doi: 10.1007/BF01567969.
Primary traumatic anterior dislocation of the shoulder in young patients has a high recurrency rate. There are varying opinions on the pathology behind the recurrences. The aim of this study was to describe the MRI characteristics of the acute lesion, and at 6-month follow-up. Thirty patients aged 18-30 years with primary traumatic anterior dislocation of the shoulder were randomized into two groups. One group was treated with acute arthroscopic lavage within 10 days. The control group was treated with traditional non-operative therapy. All patients underwent acute MRI within 10 days and before the arthroscopic lavage, and again at the 6-month follow-up, for evaluation of the lesions. The acute MRI verified Hill-Sachs lesions in all patients. At the 6-month follow-up MRI, there was no change in the size of the Hill-Sachs lesion. This was also the case with the six patients in the control group with recurrent dislocations during the first 6 months. Twenty-nine patients (97%) had joint effusion at the acute MRI, which was very useful for evaluation of the soft tissue pathology. The glenohumeral ligaments were detached in 20/30 patients (66%), and the labrum in 22/30 patients (70%). A capsulolabral detachment classified as a Baker 3 lesion was seen in 16/30 (53%) of the patients, including all six patients with recurrent dislocation. At the 6-month control only 3/30 (10%) of the patients had joint effusion for adequate evaluation of the labrum and ligamentous pathology. A Hill-Sachs lesion was found in 100% of the patients after primary dislocation, and recurrent dislocations did not change the size of the lesion. The study supports the opinion that this lesion is overlooked in the clinical situation. The joint effusion at the acute MRI was of utmost importance for evaluation of the soft tissue pathology. The 6-month MRI control was therefore considered inconclusive when evaluating capsulolabral lesions, due to lack of effusion. MRI arthrography with contrast administration would have been very helpful at the 6-month examination.
年轻患者原发性创伤性肩关节前脱位的复发率很高。对于复发背后的病理情况存在不同观点。本研究的目的是描述急性损伤以及6个月随访时的MRI特征。30例年龄在18至30岁之间的原发性创伤性肩关节前脱位患者被随机分为两组。一组在10天内接受急性关节镜灌洗治疗。对照组接受传统非手术治疗。所有患者在10天内且在关节镜灌洗前接受急性MRI检查，并在6个月随访时再次进行检查，以评估损伤情况。急性MRI证实所有患者均有希尔-萨克斯损伤。在6个月随访MRI时，希尔-萨克斯损伤的大小没有变化。对照组中在前6个月内出现复发性脱位的6例患者也是如此。29例患者（97%）在急性MRI时有关节积液，这对评估软组织病理情况非常有用。30例患者中有20例（66%）肩肱韧带断裂，22例（70%）盂唇损伤。16例（53%）患者出现了分类为贝克3级损伤的关节囊盂唇分离，包括所有6例复发性脱位患者。在6个月复查时，仅30例患者中有3例（10%）有关节积液，足以评估盂唇和韧带病理情况。初次脱位后100%的患者发现有希尔-萨克斯损伤，复发性脱位并未改变损伤大小。该研究支持这样一种观点，即这种损伤在临床情况下被忽视了。急性MRI时的关节积液对于评估软组织病理情况至关重要。因此，由于缺乏积液，在评估关节囊盂唇损伤时，6个月的MRI复查被认为是不确定的。在6个月检查时进行增强MRI关节造影会非常有帮助。
