手术治疗老年陈旧性肩关节脱位的疗效观察

EFFECTIVENESS OF SURGICAL TREATMENT FOR SENILE CHRONIC SHOULDER DISLOCATION

目的探讨老年陈旧性肩关节脱位的手术方法及临床疗效。方法 2011年10月-2014年4月,手术治疗老年陈旧性肩关节脱位7例。男2例,女5例;年龄61～83岁,平均74岁。致伤原因：摔伤6例,交通事故伤1例;受伤至确诊时间4～12周,平均6.7周。肩关节恐惧试验及Dugas征阳性。肩关节主动前屈上举（50.7±8.4）°,外展（44.5±3.3）°,外旋（35.8±4.8）°,内旋达T6、T11、L4各1例及T10、T12各2例。肩关节功能ConstantMurley评分为（51.2±8.3）分,Neer评分为（45.4±7.3）分。结果术后切口均Ⅰ期愈合,无医源性骨折、神经血管损伤等并发症发生。7例均获随访,随访时间12～18个月,平均16个月。随访期间肩关节均未出现再脱位。末次随访时,患侧肩关节恐惧试验及Dugas征均呈阴性,肩关节主动前屈上举达（117.5±13.1）°,外展（72.0±4.6）°,外旋（39.0±3.4）°,内旋达T6、T10、T12、L3各1例及T11 3例。除内旋（Ζ=—1.732,P=0.083）外,其余方向活动度均较术前显著改善,比较差异有统计学意义（t=—33.746,P=0.000;t=—30.614,P=0.000;t=—2.802,P=0.031）。肩关节功能Constant-Murley评分为（85.4±4.3）分,Neer评分为（84.0±4.8）分,均较术前明显改善,比较差异有统计学意义（t=—21.016,P=0.000;t=—29.518,P=0.000）。结论手术治疗老年陈旧性肩关节脱位能明显改善肩关节活动度及功能。

Objective To investigate the surgical treatment and effectiveness of senile chronic shoulder dislocation. Methods Between October 2011 and April 2014, 7 elderly patients with chronic shoulder dislocation were treated. There were 2 males and 5 females with an average age of 74 years（range, 61-83 years）. The causes of injuries were falling injury in 6 patients and traffic accident injury in 1 patient. The interval between injury and confirmed diagnosis was 4-12 weeks（mean, 6.7 weeks）. Preoperative apprehension test and Dugas sign of the shoulder joint were positive. Before operation, the forward elevation, abduction, and external rotation were（50.7±8.4）,（44.5±3.3）, and（35.8±4.8）°, respectively; and internal rotation reached T6, T11, L4 in 1 case and reached T10, T12 in 2 cases separately. The Constant-Murley score and Neer score were 51.2±8.3 and 45.4±7.3, respectively. Results All the incisions healed by first intention, and no complication of fracture or neurovascular injuries occurred. Seven patients were followed up 12-18 months（mean, 16 months）, and no re-dislocation happened. At last follow-up, apprehension test and Dugas sign of the shoulder joint were negative. The forward elevation, abduction, and external rotation were significantly improved to（117.5±13.1）,（72.0±4.6）, and（39.0±3.4）°（t= —33.746, P=0.000; t= —30.614, P=0.000; t= —2.802, P=0.031）; and internal rotation reached T6, T10, T12, and L3 in 1 case respectively, and T11 in 3 cases, showing no significant difference when compared with preoperative values（Ζ= —1.732, P=0.083）. The Constant-Murley score and Neer score were significantly improved to 85.4±4.3 and 84.0±4.8 when compared with preoperative score（t= —21.016, P=0.000; t= —29.518, P=0.000）. Conclusion Surgical treatment of senile chronic shoulder dislocation can improve the range of motion and function of the shoulder joint obviously.