肩关节周围骨折及术后肱骨头向下半脱位的临床分析

Clinical Analysis of Inferior Subluxation of Humeral Head after Trauma or Surgery

目的探讨肩部创伤以及手术后引起肩关节半脱位的病因、诊断及治疗特点。方法对2003年7月，2007年4月收治的26例肩部创伤以及手术后引起肩关节半脱位进行影像学分析，行肩关节外展架固定并肩部肌肉锻炼、理疗治疗。并观察治疗后效果。结果肩部创伤以及手术后易引起肩关节向下半脱位，其肩峰与肱骨头中心的垂直距离（47．42±7．85）mm与正常位置（40．70±5．49）mm相比，差异均有统计学意义（P〈0．01）。通过早期复位及功能锻炼，大部分可得到优良的结果，预后较好。结论创伤以及手术后引起肩关节向下半脱位应引起高度重视，常继发于多种因素，需要精确的评估肩部损伤以排除神经、关节囊及肩袖的损伤．提高手术治疗的效果。

Objective To discuss the etiology, course of diseases and treatment of inferior subluxation of the humeral head after trauma or surgery.Methods From July 2003 to April 2007, 26 cases of inferior subluxation of the humeral head after trauma or surgery were analyzed with X-ray films of shoulder, at the same time underwent the therapy of abducent frame immobilization and functional exercise. The effectiveness of the treatment was observed.Results The inferior subluxation of the humeral head after trauma or surgery occurred more often in vertical subluxation. The space between the central point of the humeral head and aeromion（47.42±7.85）was significantly different from those of uninvolved shoulder （40.70±5.49）.The prognosis for quick resolution of subluxation after an injury or operation to the shoulder and functional exercise was excellent.Conclusion It is important to recognize this condition for the orthopedic surgeon. The inferior subluxation of the humeral head is often secondary to many factors, needs meticulous evaluation for excluding injury of nerves, rotator cuff and capsule, and for enhancement of treatment outcome.