Abstract：
Chronic epilepsy may cause important bipolar bony lesions. We aim to compare the specific pathoanatomic metrics of the bony lesions in chronic shoulder anterior instability that occur in the epileptic population vs non-epileptic population.
METHODS: From 2006 to 2020, we included epileptic and non-epileptic patients with anterior recurrent shoulder instability. We randomly adjusted the patients of the two groups according to the sex, age and type of management. We included 50 patients. For each included patient, we performed an in-depth CT-scan analysis and comparison of the glenoid bone loss: PICO method using the best-fit circle; and the Hill-Sachs lesion: the depth and width were given as a percentage of the humeral head diameter on an axial view. We also evaluated the engaging character of the involved lesion using the On-track/Off-track analysis. Those characteristics were compared between the two groups.
RESULTS: We found a glenoid bone loss in 32 patients. Glenoid bone loss was not significantly greater in patients with epilepsy (p=0.052). A Hill-Sachs lesion was found in 42 patients (22 in epileptic group and 20 in non-epileptic group). Hill-Sachs lesions were significantly deeper and larger in the epileptic group. (depth: 22% vs 9%, p<0.001; width: 43% vs 28%, p=0.003). In the epileptic group 90% of the bone lesions were OFF-track versus 30% in the non-epileptic group. Thus, the epileptic patients presented more engaging bony lesions than non-epileptic patients (p=0.001) (OR=23).
CONCLUSIONS: In a population of epileptic patients, Hill-Sachs lesions are larger and deeper than in patients with non- epileptic shoulder instability. By contrast, there is no significant difference regarding the characteristics of the glenoid bone loss if present. This implies that bone lesions in instable shoulders of epileptic patients need at least a bony stabilization procedure on the humeral side in the majority of cases.
METHODS: From 2006 to 2020, we included epileptic and non-epileptic patients with anterior recurrent shoulder instability. We randomly adjusted the patients of the two groups according to the sex, age and type of management. We included 50 patients. For each included patient, we performed an in-depth CT-scan analysis and comparison of the glenoid bone loss: PICO method using the best-fit circle; and the Hill-Sachs lesion: the depth and width were given as a percentage of the humeral head diameter on an axial view. We also evaluated the engaging character of the involved lesion using the On-track/Off-track analysis. Those characteristics were compared between the two groups.
RESULTS: We found a glenoid bone loss in 32 patients. Glenoid bone loss was not significantly greater in patients with epilepsy (p=0.052). A Hill-Sachs lesion was found in 42 patients (22 in epileptic group and 20 in non-epileptic group). Hill-Sachs lesions were significantly deeper and larger in the epileptic group. (depth: 22% vs 9%, p<0.001; width: 43% vs 28%, p=0.003). In the epileptic group 90% of the bone lesions were OFF-track versus 30% in the non-epileptic group. Thus, the epileptic patients presented more engaging bony lesions than non-epileptic patients (p=0.001) (OR=23).
CONCLUSIONS: In a population of epileptic patients, Hill-Sachs lesions are larger and deeper than in patients with non- epileptic shoulder instability. By contrast, there is no significant difference regarding the characteristics of the glenoid bone loss if present. This implies that bone lesions in instable shoulders of epileptic patients need at least a bony stabilization procedure on the humeral side in the majority of cases.
摘要：
慢性癫痫可引起重要的双极骨性病变。我们的目的是比较癫痫人群与非癫痫人群中发生的慢性肩关节前不稳定骨病变的特定病理解剖指标。
方法：从2006年到2020年，我们纳入了患有前路复发性肩关节不稳的癫痫患者和非癫痫患者。对两组患者按性别进行随机调整,管理的年龄和类型。我们包括50名患者。对于每个纳入的患者，我们对关节盂骨丢失进行了深入的CT扫描分析和比较:使用最佳拟合圆的PICO方法;和Hill-Sachs病变:深度和宽度在轴向视图上以肱骨头直径的百分比给出.我们还使用轨道上/非轨道分析评估了受累病变的参与特征。比较两组的特征。
结果：我们发现32例患者存在关节盂骨丢失。癫痫患者的关节盂骨丢失没有明显增加（p=0.052）。在42例患者中发现了Hill-Sachs病变（癫痫组22例，非癫痫组20例）。癫痫组的Hill-Sachs病变明显更深和更大。（深度：22%对9%，p<0.001；宽度：43%vs28%，p=0.003)。在癫痫组中，90％的骨病变偏离轨道，而非癫痫组中为30％。因此，癫痫患者比非癫痫患者表现出更多的骨性病变(p=0.001)(OR=23).
结论：在癫痫患者人群中，Hill-Sachs病变比非癫痫性肩不稳定患者更大，更深。相比之下,如果存在的话，关于关节盂骨丢失的特征没有显着差异。这意味着在大多数情况下，癫痫患者不稳定肩部的骨病变至少需要肱骨侧的骨稳定程序。
方法：从2006年到2020年，我们纳入了患有前路复发性肩关节不稳的癫痫患者和非癫痫患者。对两组患者按性别进行随机调整,管理的年龄和类型。我们包括50名患者。对于每个纳入的患者，我们对关节盂骨丢失进行了深入的CT扫描分析和比较:使用最佳拟合圆的PICO方法;和Hill-Sachs病变:深度和宽度在轴向视图上以肱骨头直径的百分比给出.我们还使用轨道上/非轨道分析评估了受累病变的参与特征。比较两组的特征。
结果：我们发现32例患者存在关节盂骨丢失。癫痫患者的关节盂骨丢失没有明显增加（p=0.052）。在42例患者中发现了Hill-Sachs病变（癫痫组22例，非癫痫组20例）。癫痫组的Hill-Sachs病变明显更深和更大。（深度：22%对9%，p<0.001；宽度：43%vs28%，p=0.003)。在癫痫组中，90％的骨病变偏离轨道，而非癫痫组中为30％。因此，癫痫患者比非癫痫患者表现出更多的骨性病变(p=0.001)(OR=23).
结论：在癫痫患者人群中，Hill-Sachs病变比非癫痫性肩不稳定患者更大，更深。相比之下,如果存在的话，关于关节盂骨丢失的特征没有显着差异。这意味着在大多数情况下，癫痫患者不稳定肩部的骨病变至少需要肱骨侧的骨稳定程序。
