Evolving Concept of Bipolar Bone Loss and the Hill-Sachs Lesion: From "Engaging/Non-Engaging" Lesion to "On-Track/Off-Track" Lesion
Evolving Concept of Bipolar Bone Loss and the Hill-Sachs Lesion: From "Engaging/Non-Engaging" Lesion to "On-Track/Off-Track" Lesion
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DOI：
10.1016/j.arthro.2013.10.004
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发表时间：
2014-01-01
影响因子：
4.7
通讯作者：
Burkhart, Stephen S.
中科院分区：
文献类型：
--
作者：
Di Giacomo, Giovanni;Itoi, Eiji;Burkhart, Stephen S.
对于前部不稳定伴关节盂骨丢失占下关节盂直径的25%或以上（倒梨形关节盂），近期作者的共识是应进行关节盂植骨。尽管接合性Hill-Sachs病变已被认为是复发性前路不稳定的风险因素，但考虑到双极（肱骨侧+关节盂侧）骨丢失的各种尺寸和各种方向的几何相互作用，目前还没有普遍接受的方法来量化Hill-Sachs病变，然后将该量化纳入治疗建议。我们开发了一种方法（影像学和关节镜），使用关节盂轨道的概念来确定Hill-Sachs病变是否会与前关节盂边缘接合，是否伴有前关节盂骨丢失。如果Hill-Sachs病变参与，则称为“偏离轨道”Hill-Sachs病变;如果不参与，则称为“轨道上”病变。在我们的定量方法的基础上，我们已经为所有前路不稳定患者（包括伴或不伴双极骨丢失的患者）制定了一种具有特定手术标准的治疗范例。
For anterior instability with glenoid bone loss comprising 25% or more of the inferior glenoid diameter (inverted-pear glenoid), the consensus of recent authors is that glenoid bone grafting should be performed. Although the engaging Hill-Sachs lesion has been recognized as a risk factor for recurrent anterior instability, there has been no generally accepted method for quantifying the Hill-Sachs lesion and then integrating that quantification into treatment recommendations, taking into account the geometric interplay of various sizes and various orientations of bipolar (humeral-sided plus glenoid-sided) bone loss. We have developed a method (both radiographic and arthroscopic) that uses the concept of the glenoid track to determine whether a Hill-Sachs lesion will engage the anterior glenoid rim, whether or not there is concomitant anterior glenoid bone loss. If the Hill-Sachs lesion engages, it is called an "off-track" Hill-Sachs lesion; if it does not engage, it is an "on-track" lesion. On the basis of our quantitative method, we have developed a treatment paradigm with specific surgical criteria for all patients with anterior instability, both with and without bipolar bone loss.