Rotational humeral osteotomy for recurrent anterior dislocation of the shoulder associated with a large Hill-Sachs lesion

Rotational subcapital osteotomy of the humerus for recurrent anterior dislocation of the shoulder associated with a large Hill-Sachs lesion was performed first by us in 1964 as a trial. From 1967 through 1981, 207 rotational humeral osteotomies were performed. Follow-up was possible on 180 of these shoulders. The over-all redislocation rate was 5.7 per cent and the rate of non-traumatic redislocation, 1.1 per cent. Limitation of motion of more than 10 degrees was present in only 3.9 per cent, the maximum limitation of external rotation being 15 degrees in one patient. The average loss of external rotation was less than 5 degrees, without noticeable diminution of power or function in most patients. The results as graded by a standard rating scale were good to excellent in 90 per cent, fair in 3 per cent, and poor in 7 per cent of the patients. The fair and poor results were due to redislocation, delayed union or non-union, post-traumatic arthritis, and over-rotation at the osteotomy site. Reoperation was necessary in two patients with a non-traumatic recurrence, in six patients with delayed union or non-union, and in one patient with excessive rotation at the osteotomy site. Plate removal was performed one to two years postoperatively in 107 of the 180 shoulders. Of the 321 recurrent dislocations seen over the fourteen-year period, 65 per cent were associated with a moderate to severe posterior-superior impression fracture of the humeral head (Hill-Sachs lesion).(ABSTRACT TRUNCATED AT 250 WORDS)     

Location of the Hill-Sachs lesion in shoulders with recurrent anterior dislocation

Introduction  Computed tomography images of 35 shoulders of 34 patients with recurrent anterior dislocation and 13 shoulders of 13 healthy normal volunteers were used to determine the location of the Hill-Sachs lesion in reference to the location of the bare area using computed tomography. Method  We measured the location, and size of the Hill-Sachs lesion and the bare area, and described them on a clock face on the humeral head. Results  The Hill-Sachs lesion was observed in slices between 0–3 and 22–24 mm distal from the top of the humeral head. The bare area was located only in slices 19–21 mm and below. Conclusion  From these data, we concluded that the Hill-Sachs lesion exists in the area between 0 and 24 mm from the top of the humeral head, and the inferior portion of the Hill-Sachs lesion overlaps the bare area if it extends beyond 19 mm from the top of the humeral head.     

Correlation between Bankart and Hill-Sachs lesions in anterior shoulder dislocation

Background: Bankart lesions and Hill‐Sachs lesions are commonly associated with anterior shoulder dislocations. The presence of Bankart lesion indicates the need for surgical repair. Magnetic resonance imaging (MRI) has been shown to be sensitive in detecting these two lesions. The aim of this study is to investigate the correlation between Bankart lesions and Hill‐Sachs lesions on MRI for patients with traumatic anterior shoulder dislocations. Methods: Between 2003 and 2005, 61 patients from Alfred and Sandringham Hospitals had an MRI as part of the investigation for traumatic anterior shoulder dislocations. The MRI scans were reviewed and subsequently confirmed by a radiologist to show the presence or absence of Bankart and Hill‐Sachs lesions. The data were then analysed by a statistician. Results: Although patients with one of these lesions were more than two‐and‐a‐half times as likely to have the other, small study numbers precluded this result from achieving statistical significance. (odds ratio, 2.67 (0.83–8.61), P = 0.10). Younger age was a strong predictor of a recurrence of shoulder dislocation (odds ratio, 0.93 (0.89–0.98), P = 0.005). The presence of Bankart or Hill‐Sachs lesions on MRI for the primary shoulder dislocation group was similar to the recurrent group (73% vs. 72% for Bankart lesion and 67% vs. 70% for Hill‐Sachs lesion). Conclusion: There is a strong correlation between both lesions. This apparent trend can be useful in predicting the presence of a Bankart lesion when a Hill‐Sachs lesion is identified on a plain radiograph. This study suggests the consideration of surgical repair after identification of a Hill‐Sachs lesion on plain radiographs, especially for younger patients where the rate of re‐dislocation is high.     

Radiographic evaluation of the Hill-Sachs lesion in patients with recurrent anterior shoulder instability

The Hill-Sachs lesion is an important bony sign of previous anterior shoulder dislocation and instability. Using orthographic projection, we evaluated the Hill-Sachs lesion in 30 shoulders in 27 patients with recurrent anterior shoulder instability. This produced a clear and undistorted view of the posterolateral notch. For orthographic imaging, the patient was placed supine with the arm in 135 degrees of flexion and 15 degrees of internal rotation. The x-ray beam was angled vertically through the humeral head. The width and depth of the posterolateral notches were measured on the orthographic radiographs. The average posterolateral notch depths were 3.9 +/- 0.9 mm in the dislocation group and 2.1 +/- 1.0 mm in the subluxation group. A shallow Hill-Sachs lesion was indicative of a greater degree of anterior instability of the shoulder.     

Hill-Sachs损伤伴肩关节前方不稳的镜下手术治疗

[目的]探讨关节镜下盂唇修补联合Remplissage技术治疗伴有Hill-Sachs缺损的肩关节前方不稳的临床效果。[方法]2012年2月~2015年2月,60例复发性肩关节前方不稳接受关节镜下盂唇修补联合Remplissage手术治疗,其中男50例,女10例。手术时平均年龄29.30岁(21.50~45.80岁)。所有病例术前均证实存在前方盂唇损伤和明显的Hill-Sachs损伤,所有患者均由同一名医生施行关节镜下手术。[结果]术前肩关节不稳ISIS评分(3.80±0.70)分。平均随访时间16.6个月(12~23个月)。所有患者术后肩关节前屈上举、内旋及体侧外旋活动度与术前无明显差异。ASES评分由术前的(85.23±13.45)分增加至末次随访时的(94.11±8.16)分,差异具有统计学意义(P<0.01)。Constant-Murley评分由术前的(95.92±3.41)分增加至末次随访时的(98.94±2.40)分,两时间点差异具有统计学意义(P<0.01);Rowe评分由术前的(42.12±4.92)分增加至末次随访时的(88.11±3.55)分,差异具有统计学意义(P<0.01)。末次随访未发现有再次肩关节脱位者。[结论]关节镜下前方关节囊修补联合Remplissage手术治疗合并Hill-Sachs缺损的临床效果满意,能够有效重建肩关节功能,避免术后再脱位的发生。     

复发性肩关节前脱位与关节内继发损伤的相关性研究

目的通过分析肩关节前脱位次数、病程与关节内继发损伤的关系,探讨复发性肩关节前脱位对关节内继发损伤的影响。方法回顾分析2005年1月-2009年6月关节镜下应用缝合锚钉行Bankart重建术治疗的59例复发性肩关节前脱位患者临床资料。男48例,女11例;年龄15～42岁,平均27.6岁。初次脱位原因:接触性体育运动21例,非接触性体育运动13例,日常活动11例,外伤14例。术前脱位3～32次,平均10.6次。初次脱位至手术时间为11个月～12年,中位时间5.9年。患者恐惧试验及复位试验均呈阳性。术前美国加州大学洛杉矶分校(UCLA)肩关节功能评分为(22.3±2.4)分,Constant-Murley评分为(73.1±5.8)分。关节镜下观察关节内继发损伤情况,并进行统计分析。结果术后患者切口均Ⅰ期愈合。患者均获随访,随访时间16～58个月,平均37.3个月。末次随访时,UCLA肩关节功能评分为(34.6±1.7)分,Constant-Murley评分为(86.7±6.1)分,与术前比较差异均有统计学意义(P<0.05)。术前关节脱位次数和关节软骨损伤的严重程度成正相关(rs=0.345,P=0.007),和Hill-Sachs损伤严重程度成正相关(rs=0.708,P=0.000);首次脱位至手术时间和关节软骨损伤严重程度成正相关(rs=0.498,P=0.000),与Hill-Sachs损伤严重程度无相关性(rs=0.021,P=0.874)。结论复发性肩关节前脱位早期行Bankart重建有利于肩关节功能恢复,避免或延缓关节内继发损伤的发生和发展。     

肩关节镜治疗复发性肩关节前脱位

目的 对关节镜治疗复发性肩关节前脱位的疗效进行评价.方法 2001年1月至2006年3月关节镜治疗复发性肩关节前脱位患者52例,其中44例获得随访,随访时间12～54个月,平均26个月.对获得随访的44例患者的临床资料进行回顾性研究.采用美国加州洛杉矶大学肩关节评分系统(UCLA)、肩关节简明测试(SST)、Dawson评分对术后效果进行评价.采用Dawson评分对患者年龄、是否存在松弛、术前脱位频率、复位情况和病程长短等因素对术后疗效的影响进行评价.结果 获得随访的44位患者的脱位复发率为4.5%.术后UCLA、SST、Dawson评分与术前比较差异具有统计学意义,肩关节镜治疗术后优良率在91%以上.患者年龄、病程长短、术前脱位频率、是否伴有关节松弛、复位方法对治疗效果无明显影响.结论 关节镜治疗复发性肩关节前脱位手术效果较好,术后肩关节功能改善明显.     

复发性肩关节前方不稳定的诊断与治疗

复发性肩关节前方不稳定是我们在临床工作中经常能碰到的一类问题。目前,该病的发病机制、诊断方法以及治疗手段均有了极大的进展。基础研究方面,从明确盂肱韧带在肩关节不稳定发病中的重要意义发展到目前认为肩关节的稳定是由肩关节周围的主动、被动稳定结构的综合作用的结果。诊断方面,在传统的病史、查体及X线片等方法的基础上进一步引入了MRI、麻醉下查体以及关节镜检查等新的方法。关于该病的治疗,一方面切开手术治疗尤其是Bankart修补术已日益成熟并成为治疗的金标准;另一方面,关节镜下修补术由于其突出的优势在近来获得了迅速的发展,并逐步取得了与切开手术近似的效果。     

肩关节交锁后脱位合并反向Hill-Sachs的改良关节镜下治疗

[目的]介绍关节镜下改良的Mclaughlin技术及后方盂唇修补治疗肩关节后脱伴啮合性Hill-Sachs损伤。[方法] 2015年3月～2017年5月,本院收治5例绞锁性肩关节后脱位患者,其中男4例,女1例;年龄35～51岁,平均(41.30±3.50)岁,受伤至手术时间平均为(3.10±0.60)个月,术前CT三维均证实为绞锁性的肩关节后脱位,肱骨头前缘缺损(反Hill-Sachs) 20%～40%,采用改良的Mclaughlin技术及后方盂唇修补的手术方式治疗,采用ASES、Constant-Murley和Rowe评分评定临床效果。[结果]随访6～24个月,平均(18.50±4.60)个月。末次随访时ASES、Constant-Murley和Rowe评分均较术前有显著增加,差异有统计学意义(P0.001)。所有患者末次随访时均获得良好生活与运动能力,无患者发生再次患肩脱位。[结论]关节镜下改良的Mclaughlin技术治疗绞锁性肩关节后脱位疗效良好。     

The Magnuson-Stack operation for recurrent anterior dislocation of the shoulder

Summary A retrospective review was carried out on 44 patients with recurrent anterior dislocation of the shoulder who were treated by the Magnuson-Stack operation. The average follow up was 12 years. There were 2 recurrences. Twenty-five patients had no symptoms, 3 had pain, 6 complained of subjective instability, and 8 had more than 10° restriction of external rotation. No patients had signs of osteoarthritis in the joint. The satisfactory results and the ease of the operation are reasons for advocating this procedure.

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Résumé Revue rétrospective de 44 patients traités par la technique de Magnuson-Stack pour luxation récidivante antérieure de l'épaule. L'âge moyen des malades au moment de l'opération était de 28 ans (15–60), le recul moyen des observations est de 12 ans (6–17). Dans tous les cas on a constaté une limitation moyenne de la rotation externe, de 12° (5–50) avec l'épaule en adduction et de 14° (5–50) avec l'épaule en abduction de 90°. On n'a jamais retrouvé de signes radiologiques de détérioration articulaire au dernier examen. Les complications les plus importantes ont été deux luxations durant la période post-opératoire (4.5%), respectivement aux 5ème et 8ème mois. Chez les 42 autres malades le résultat peut être considéré comme satisfaisant: 25 sont asymptomatiques, 3 présentent une légère douleur, 6 une certaine sensation d'instabilité et 8 ont une limitation de la rotation externe supérieure à 10°.

     

关节镜下Bankart损伤修复联合Remplissage填塞术治疗合并Hill-Sachs缺损的成年人复发性肩关节前脱位

目的:探讨关节镜下Bankart损伤修补术联合Remplissage填塞术治疗复发性肩关节前脱位合并Hill-Sachs损伤的方法和临床疗效.方法:回顾性分析2016年3月至2019年3月行关节镜下Bankart损伤修复治疗关节盂骨缺损＜20％的复发性肩关节前脱位患者106例,其中男76例,女30例;年龄18～45(2...     

复发性肩关节前脱位的临床病理表现

目的通过肩关节镜全面了解复发性肩关节前脱位的临床病理表现。方法52例复发性肩关节前脱位患者行关节镜检查,男38例,女14例;年龄16～49岁,平均24.7岁;脱位次数3～15次,平均7.4次。除2例癫痫外,其余50例患者在全麻下行平移试验及Sulcus试验,依照Hawkins分类系统记录试验结果,如果向前、后、下移位超过2°,则为肩关节松弛。50例患者中,32例肩关节松弛,归为关节松弛组,男22例,女10例;18例无肩关节松弛,为单纯创伤性复发性前脱位,归为单纯创伤组,男14例,女4例。记录镜下病理改变并对比两组镜下病理改变的差异。结果51例患者有前下盂唇损伤,50例有Hill-Sachs损伤,32例有肱二头肌腱炎症或损伤,30例有前下盂骨、软骨的损伤,29例有SLAP损伤,7例有肩袖损伤。前下盂唇损伤时,单纯创伤组磨损消失较多(P=0.055),关节松弛组ALPSA损伤较多(59.4%对38.9%,P=0.164)。单纯创伤组前下盂软骨及骨损伤较多(P=0.083,P=0.052)。Hill-Sachs损伤,在关节松弛组以浅或软骨性损伤为主,在单纯创伤组以较宽深或骨性损伤为主。结论复发性肩关节前脱位最常见的病理改变依次为:前下盂唇损伤,Hill-Sachs损伤,肱二头肌腱炎症或损伤,前下盂的骨、软骨损伤,SLAP损伤,肩袖损伤。肩关节松弛伴肩关节复发性前脱位患者镜下病理改变相对较轻。     

关节镜下手术治疗肩关节习惯性前脱位

<正>2008年6月~2011年12月,我科在关节镜下手术治疗21例肩关节习惯性前脱位患者,效果满意,现报道如下。1材料与方法1.1病例资料本组21例,男14例,女7例,年龄16~63岁。左肩7例,右肩14例。损伤原因:投掷伤12肩,暴力摔伤6肩,高处坠落伤3肩。初次脱位后均行过手法复位,其中11例患肢首次脱位后未行固定,10例患肢行绷带悬吊固定1~3周,继而习惯性脱位发生,脱     

复发性肩关节前脱位关节镜手术治疗进展

复发性肩关节前脱位的手术治疗是运动损伤医学领域中的一个难题,其主要原因在于无法较好地恢复肩关节动力性及骨性约束.目前国内外大多采用关节镜手术治疗,术后总体效果满意,但具体术式的选择仍存在较大争议.临床中需根据关节盂及肱骨头骨性缺损的有无及大小,选择不同方案治疗.笔者建议:无关节盂骨性缺损或关节盂骨性缺损＜20％,选用B...     

Anterior capsulolabral reconstruction for traumatic recurrent anterior shoulder dislocation

The anterior capsulolabral reconstruction (ACLR) has been shown to yield satisfactory results predominantly in overhead athletes with atraumatic anterior shoulder instability. The purpose of this study was to assess the clinical results of patients who underwent ACLR for recurrent traumatic anterior shoulder dislocation. A retrospective review of 41 patients, mean age 29 (range: 16 to 55 years) who underwent ACLR for traumatic recurrent anterior shoulder dislocation was performed. All patients reported a traumatic anterior shoulder dislocation with subsequent recurrent instability. Seven patients had undergone previous shoulder stabilization surgery which had failed. The mean number of previous dislocations was 4.5 (range: 1 to 15). There were 31 males and 10 females, and the dominant arm was involved in 24 patients. In all cases, the capsulolabral complex was detached from the glenoid rim. The mean follow-up was 3.6 years (range: 15 to 80 months). All patients were evaluated by physical examination. The mean modified Rowe score was 93.6 (range: 65 to 100). There were 32 excellent, 5 good, 1 fair, and 2 poor results. Instability was eliminated in 38 patients (93%). Of 25 patients who engaged in recreational sports, all were able to return to their previous level of participation. One patient sustained a traumatic redislocation and underwent revision surgery. Two patients reported atraumatic recurrent subluxation with one requiring revision surgery due to persistent symptoms of instability. There was no loss of range of motion in comparison to preoperative values. Of the seven shoulders that had undergone previous surgery, all remain stable. These results indicate that a glenoid-sided capsulolabral reconstruction can restore shoulder stability in patients with recurrent traumatic anterior shoulder dislocation. Success rates comparable to those of other open anterior shoulder repair procedures can be achieved.