新改良McLaughlin技术治疗肩关节后脱位

Re-modified McLaughlin technique for treatment of posterior dislocation of shoulder

目的探讨新改良McLaughlin技术治疗肩关节后脱位的临床效果。方法回顾性分析自2013-01-2014—06采用新改良McLaughlin技术治疗的7例肩关节后脱位。取肩关节前侧入路，将头静脉牵向内侧并保护，将胸大肌向内侧牵开，三角肌向外侧牵开显露肱骨近端；切开肩胛下肌，标记其两端。将肩胛下肌近侧牵向内侧，显露骨折，骨膜剥离子橇拨复位肱骨头；若合并肱骨近端骨折，复位骨折，选用接骨板系统或者空心钉固定骨折。结果7例均获得随访12—24个月，平均18．28个月。骨折均一期愈合，愈合时间7～14周，平均10．14周。1例术后复查X线片显示患侧肱骨骨折对位良好，肱骨头向后半脱位；末次随访时肩关节活动度：前屈上举约70°，体侧外旋约20°，体侧内旋L4水平；VAS评分4分，肩关节UCLA评分23分。其他6例术后复查X线片及CT均显示关节位置恢复正常．骨折对位对线良好：末次随访时肩关节活动度：前屈上举100°-165°，体侧外旋50°-70°，体侧内旋T10-L1水平；VAS评分0～2分，平均0．67分；肩关节U-CLA评分25—33分，平均29．67分。结论新改良McLaughlin技术治疗肱骨头缺损〈40％且不伴有肱骨近端Neer4部分骨折的肩关节后脱位可取得满意的临床结果，术后患者肩关节功能恢复良好。

Objective To explore the therapeutic effect of re-modified McLaughlin technique for the treatment of shoulder dislocation. Methods Seven patients received surgical treatment from January 2013 to July 2014. All patients were treated through the deltopectoral approach, and their cephalic vein was pulled inward to protect. Subscapularis was cut off and the ends were marked after exposure to the proximal humerus. Posterior dislocation of the shoulder was reset by using a periosteum detaeher, and then the combined fracture was reset and fixed with internal fixation plate and cannulated screws. Results Seven patients were followed up for 12-24 months （average, 18.28 months）, and all of the fractures united in 7-14 weeks （average, 10.14 weeks）. X-ray of one patient after surgery showed the ipsilateral shoulder subluxation, and at the final follow-up, the forward flexion and elevation was 70°, the internal rotation was L4 level, the external rotation was 20° and the VAS was 2, the UCLA was 23. Another eases achieved better outcome of shoulder joint functions at the last follow-up. The range of forward flexion and elevation was 100°-165°, the range of cxtemal rotation was 50°-70°, the internal rotation range from L1 level to T10 level, and the VAS was 0-2 （average, 0.67）, the UCLA was 25-33 （average 29.67）. Conclusion For the treatment of posterior dislocation of the shoulder, this operation has achieved satisfactory clinical results. The patients with posterior dislocation of the shoulder who have defect of up to 40% of the articular surface of the caput humeri, or fractures of proximal humerus（Neer 4 part fractures） and serious injure of rotator cuff are not suitable for this surgery.