肩关节后脱位伴反Hill-Sachs损伤的诊疗分析

Diagnosis and treatment of posterior shoulder dislocation combined with reverse Hill-Sachs lesion

目的探讨肩关节后脱位伴反Hill-Sachs损伤的诊疗。方法回顾性分析2022年8月至2022年11月青岛大学附属医院关节外科收治的2例男性肩关节后脱位伴反Hill-Sachs损伤患者。病例1,男性46岁,右肩关节,伤后1 d入院;病例2,男性57岁,右肩关节,伤后2 d入院。2例患者致伤原因均为电击伤,均为新鲜骨折,且损伤面积均>50%。均采用胸大肌三角肌入路,对塌陷的肱骨头进行解剖复位后植入人工骨并多枚埋头螺钉固定。分别采用肩关节Constant-Murley评分和视觉模拟评分(VAS)对患者治疗后的肩关节功能及疼痛进行评价。结果2例患者均未发生切口感染、臂丛神经和血管损伤等围术期并发症。术后3个月复查:病例1,肩关节前屈110°,外展90°,外旋(中立位)30°,内旋(中立位)70°,Constant-Murley肩关节评分70分,VAS评分3分。病例2,肩关节前屈130°,外展120°,外旋(中立位)50°,内旋(中立位)80°,Constant-Murley肩关节评分75分,VAS评分2分。结论对于肩关节后脱位伴反Hill-Sachs损伤,肱骨头塌陷>50%的患者采用切开复位螺钉内固定术加人工骨植骨术可取得较好的近期疗效。

Objective To explore the diagnosis and treatment of posterior shoulder dislocation combined with reverse Hill-Sachs lesion.Methods Two male patients were treated at Department of Joint Surgery,Affiliated Hospital of Qingdao University for posterior shoulder dislocation combined with reverse Hill-Sachs lesion from August to November 2022.Case 1 was a 46-year-old man,admitted 1 day after right should injury,and case 2 a 57-year-old man,admitted 2 days after right should injury.The injury was caused by electric shock in both,and their fractures were fresh with an injury area>50%.After anatomical reduction of the collapsed humeral head via the pectoralis major deltoid approach,an artificial bone was implanted and fixated with countersunk screws in both cases to reduce the shoulder joint.The Constant-Murley scale and visual analogue scale(VAS)were used to evaluate the functional recovery of the shoulder and pain after treatment.Results No such perioperative complications as incision infection,brachial plexus injury or vascular injury was observed in either of the 2 patients.Reexamination 3 months after surgery showed in case 1:110°of shoulder anterior flexion,90°of shoulder abduction,30°of external rotation(neutral position),70°of internal rotation(neutral position),70 points of Constant-Murley shoulder score,and 3 points of VAS pain score;in case 2:130°of shoulder anterior flexion,120°of shoulder abduction,50°of external rotation(neutral position),80°of internal rotation(neutral position),70 points of Constant-Murley shoulder score,and 2 points of VAS pain score.Conclusion For patients with posterior shoulder dislocation complicated with reverse Hill-Sachs lesion and humeral head collapse greater than 50%,open reduction and screw internal fixation combined with artificial bone grafting can achieve good short-term curative efficacy.