漏诊肩关节后脱位的治疗探讨

Approaches to treatment for missed posterior dislocation of shoulder

目的 探讨肩关节后脱位的相关诊断方法的意义和治疗效果。方法 对 7例漏诊的肩关节后脱位进行创伤系列X线和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。行早期闭合复位 4例 ;陈旧性脱位的 3例 ,其中 2例行切开复位内固定 ,1例放弃复位。结果 CT、X线肩关节侧位和Velpeau腋位分别显示 7例肩关节后脱位 ,腋窝位显示 3例肩关节后脱位 ;CT和腋窝位X线检查同时显示伴随骨折。随访 3～ 6年 ,闭合复位者 ,UCLA评分 32～ 35分 ;切开复位者 ,UCLA评分 1 4分 ;未予复位者 ,UCLA评分 2 2分。结论 临床对该症认识不足是造成漏诊的主要原因。

Obiective To evaluate diagnostic procedure and treatment for posterior dislocation of shoulder. Methods X ray examination and CT scanning were performed on 7 cases of missed diagnosis for posterior dislocation of shoulder. Treatment protocol was selected on the basis of delayed period following injury, clinical manifestations and imaging results. Early closed replacement was undertaken in 4 out of these 7 patients. Open reduction and fixation was performed in 2 patients of the other 3 with old dislocation, and no reduction was given to the last case. Results Posterior dislocation of shoulder was identified with both CT and roentgenogram in lateral, and Velpeau axillary positions of shoulder. In axillary position, X-ray imaging revealed 3 cases of posterior dislocation. CT scanning plus roentgenogram in axillary position clearly showed the companying fracture. All the 7 patients were followed up for 3 to 6 years. For those who received closed reduction, UCLA score ranged from 43 to 35; this sore was 14 in the patients treated with open reduction and fixation, while the one patient without any reduction got only 22 score of UCLA. Conclusions The main reason for missed diagnosis of the disorder was lacking knowledge of it in clinical practice. Early closed reduction could produce excellent restoration to function of shoulder joint.