肩关节后脱位的诊断与治疗

Diagnosis and treatment of posterior dislocation of the shoulder

目的 探讨肩关节后脱位相关诊断方法的意义和治疗效果。方法 对 5例漏诊的肩关节后脱位进行创伤系列X线检查和CT扫描检查。根据伤后延误时间、临床症状和影像学检查结果选择治疗方法。 3例行早期闭合复位 ;2例陈旧脱位中 ,1例行切开复位内固定 ,1例放弃复位。结果 CT、MRI和肩关节侧位、腋窝位、Velpeau腋窝位X线片分别显示 5例、1例、5例、2例、5例肩关节后脱位 ;CT和腋位X线检查同时显示伴随骨折。随访 2～ 5年 ,闭合复位者UCLA评分 32～ 35分 ;切开复位者UCLA评分 14分 ;未予复位者UCLA评分 2 2分。结论 临床上对该症认识不足是造成漏诊的主要原因 。

Objective To explore the significance of involved diagnostic examinations and the effects of treatment of posterior dislocations of the shoulder. Methods The trauma series of radiological examination and CT scan were used in 5 cases of neglected posterior dislocations of the shoulder. The therapy opinion was based on the time between injury and diagnosis, clinical symptoms and the findings of radiological examinations. Three acute cases were treated with close reduction. One of the 2 cases of chronic dislocations was treated with open reduction and internal fixation, and the other case was skillfully neglected. Results CT scan, MRI, lateral view, axillary view and Velpeau axillary view revealed respectively 5 cases, 1 case, 5 cases, 2 cases, 5 cases of posterior dislocations of humeral head. CT scan , axillary view and Velpeau axillary view could show the complicated fractures. After 2～5 years of follow up, The UCLA score was 32～35 points for acute cases, 14 points for the open reduced case, and 22 points for the skillfully neglected case. Conclusion Lack of clinical experience and misunderstanding of A P view of radiograph were among the main causes leading to the miss of diagnosis in posterior dislocation of the shoulder. CT scan and trauma series of radiological examination are of importance in the diagnosis. Early close reduction usually yields satisfactory results.