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中华肩肘外科电子杂志 ›› 2022, Vol. 10 ›› Issue (03) : 193 -197. doi: 10.3877/cma.j.issn.2095-5790.2022.03.001

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肩关节Hill-Sachs损伤的诊疗现状
齐岩松1, 张子恒2, 包呼日查1, 徐永胜1,()   
  1. 1. 010017 内蒙古自治区人民医院骨关节科(运动医学中心)
    2. 010110 内蒙古医科大学研究生院
  • 收稿日期:2022-06-30 出版日期:2022-08-05
  • 通信作者: 徐永胜
  • 基金资助:
    内蒙古自治区人民医院院内基金项目(201810、201501); 内蒙古自治区科技计划项目(201602098)

Current concept in the diagnosis and treatment of Hill-Sachs lesions

Yansong Qi1, Ziheng Zhang2, Huricha Bao1   

  • Received:2022-06-30 Published:2022-08-05
引用本文:

齐岩松, 张子恒, 包呼日查, 徐永胜. 肩关节Hill-Sachs损伤的诊疗现状[J]. 中华肩肘外科电子杂志, 2022, 10(03): 193-197.

Yansong Qi, Ziheng Zhang, Huricha Bao. Current concept in the diagnosis and treatment of Hill-Sachs lesions[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2022, 10(03): 193-197.

作为人体活动范围最大的关节,肩关节有着最高的脱位发生率。据报道,在美国每年每十万人中就有11~51人自诉发生过肩关节脱位[1,2,3],其中,肩关节前脱位占绝大多数(95%~97%)[4]。肩关节前脱位在临床工作中十分常见,常因外伤引起,当手臂外旋外展时,由于肱骨头被动向前推,肩部的关节囊结构被拉伸导致撕裂,肱骨头进一步向前和向下平移导致脱出,该过程中常常伴随Hill-Sachs损伤(Hill-Sachs lesions, HSLs)[2]。发生肩关节前下方脱位时,肱骨头的后上外侧撞击前关节盂前缘,导致压缩性骨折。该损伤在复发性前脱位的患者中几乎高达100%[5]。HSLs中肱骨头后方骨缺损往往伴随着关节盂前唇骨折和支持韧带的损伤,每次脱位软组织都会逐渐薄弱,最终导致肩关节静态稳定性的丧失和生物力学环境的改变,使柔软的肱骨松质骨和坚硬的关节盂边缘皮质骨之间发生更频繁的接触,这种恶性循环往往伴随着肩部的疼痛、运动功能障碍和更加频繁的脱位,最终导致肩关节退行性变。近年,相继有一些研究报道HSLs在诊断和治疗方面的探索,根据Di Giacomo等[6]和Sheean等[7]对关节盂轨道概念的描述,其定义为当手臂以恒定姿势外旋外展时,肱骨头后外侧与关节盂相接触的区域。大体来看,关节盂轨道是一条画在与肩袖足印区内缘相等的距离上的平行线,如果Hill-Sachs病变延伸到该接触区域内侧的位置,则会钩住或接合到功能位的肩袖,这引起了人们对关节盂和肱骨缺陷组合的关注。目前治疗方案选择包括保守治疗、软组织修复和缺损重建,同时年龄和肥胖等患者因素、病理因素和相关的软组织损伤、关节盂骨缺损程度、关节囊质量、肱骨头情况、肩关节柔韧度、运动强度要求等因素被更加重视[8]。术前影像学评价肱骨头骨缺损的程度是指导手术干预的一个重要指标,Provencher等[1]认为超过25%的骨丢失则需进行关节突重建,目前关节镜下前关节囊加强是主流干预方式,其他技术也表现出了良好的临床效果。本文拟对肩关节HSLs的诊断和治疗方面的既往研究进行总结及详细介绍。

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