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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Engaging Hill-Sachs Defects
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Engaging Hill-Sachs Defects

机译：参与希尔萨克斯缺陷

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Objectives: Anatomic studies have demonstrated that bipolar glenoid and humeral bone loss have a cumulative impact on shoulder instability, and that these defects may engage in functional positions depending on their size, location, and orientation, potentially resulting in failure of stabilization procedures. Determining which lesions pose a risk for engagement remains a challenge, with arthroscopic assessment and Itoi’s 3DCT based glenoid track method being the accepted approaches at this time. The purpose of this study was to investigate the interaction of humeral and glenoid bone defects on shoulder engagement in a cadaveric model. Two alternative approaches to predicting engagement were evaluated; 1) CT scanning the shoulder in abduction and external rotation 2) measurement of Bankart lesion width and a novel parameter, the intact anterior articular angle (IAAA), on conventional 2D multi-plane reformats. The results of these two approaches were compared to the results obtained using Itoi’s glenoid track method for predicting engagement. Methods: Hill-Sachs and Bony Bankart defects of varying size were created in 12 cadaveric upper limbs, producing 45 bipolar defect combinations. The shoulders were assessed for engagement using cone beam CT in various positions of function, from 30 to 90 degrees of both abduction and external rotation. The humeral and glenoid defects were characterized by measurement of their size, location, and orientation. Diagnostic performance measures for predicting engagement were calculated for both the abduction external rotation scan and 2D IAAA approaches using the glenoid track method as reference standard. Results: Engagement was predicted by Itoi’s glenoid track method in 24 of 45 specimens (53%). The abduction external rotation CT scan performed at 60 degrees of glenohumeral abduction (corresponding to 90 degrees of abduction relative to the trunk) and 90 degrees of external rotation predicted engagement accurately in 43 of 45 specimens (96%), with sensitivity and specificity of 92% and 100% respectively. A logistic model based on Bankart width and IAAA provided a prediction accuracy of 89% with sensitivity and specificity of 91% and 87%. Inter-rater agreement was excellent (Kappa = 1) for classification of engagement on the abduction external rotation CT, and good (intraclass correlation = 0.73) for measurement of IAAA. Conclusion: Bipolar lesions at risk for engagement can be identified using an abduction external rotation CT scan at 60 degrees of glenohumeral abduction and 90 degrees of external rotation, or by performing 2D measurements of Bankart width and IAAA on conventional CT multi-plane reformats. This information will be useful for decision making in the setting of bipolar bone defects prior to shoulder stabilization.
机译：目的：解剖学研究表明，双相关节盂和肱骨丢失对肩不稳具有累积影响，并且这些缺损可能取决于其大小，位置和方向而处于功能性位置，从而可能导致稳定程序失败。关节镜评估和基于Itoi的基于3DCT的关节盂追踪方法是目前公认的方法，因此确定哪种病变会带来接合风险仍然是一个挑战。这项研究的目的是研究在尸体模型中肱骨和盂盂骨缺损与肩部接合的相互作用。评价了两种预测参与度的替代方法; 1）CT在外展和外旋中扫描肩关节2）测量Bankart病变宽度和传统2D多平面重塑格式的新参数，完整的前关节角（IAAA）。将这两种方法的结果与使用Itoi的关节盂跟踪法预测参与度的结果进行了比较。方法：在12个尸体上肢中产生大小不同的Hill-Sachs和Bony Bankart缺陷，产生45种双极缺陷组合。使用锥束CT在不同功能位置（外展和外旋均30至90度）评估肩膀的接合情况。肱骨和盂盂缺损的特征在于其大小，位置和方向的测量。以关节盂跟踪法为参考标准，针对外展外旋扫描和二维IAAA方法计算了预测接合的诊断性能指标。结果：通过Itoi的关节盂追踪方法预测了45个标本中的24个（53％）的订婚。外展CT扫描是在60例盂肱外展（相对于躯干外展为90度）和90度外展时准确地预测了45个样本中的43个（96％）的接合，敏感性和特异性为92 ％和100％。基于Bankart宽度和IAAA的逻辑模型提供了89％的预测准确性，敏感性和特异性分别为91％和87％。对于外展外旋CT上的参与分类，评分者之间的一致性非常好（Kappa = 1），对于IAAA的测量，评分者之间的一致性很好（类内相关= 0.73）。结论：可以通过在肱骨头外展60度和外旋90度的情况下进行外展外旋CT扫描，或对常规CT多平面重整格式进行Bankart宽度和IAAA的二维测量，来识别有接合风险的双相性病变。该信息对于在肩膀稳定之前双极性骨缺损的设置中的决策很有用。

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