肩关节后脱位合并巨大肩袖撕裂一例报告并文献复习

Mechanisms of muscle degeneration in rotator cuff tears

目的探讨肩关节后脱位合并巨大肩袖撕裂的受伤机制、临床表现、合并症、手术治疗及其预后情况。方法报道我院2015年收治的1例肩关节后脱位合并巨大肩袖撕裂患者,同时检索1950年1月至2016年2月期间公开发表的病例报道,检索数据库包括Pub Med、OVID、Springer、Science Direct和中文知网、万方数据库、维普数据库,并将纳入的病例报道一并进行分析讨论。结果既往共有5篇文献报道了6例肩关节后脱位伴巨大肩袖撕裂的患者,加上本例共7例。患者平均年龄35（22-55）岁。全部为暴力损伤所致,其中5例为车祸,2例为对抗性运动。仅1例为开放性损伤,6例为闭合性损伤。所有患者均累及冈上肌和冈下肌,其中4例还累及到肩胛下肌,仅2例累及小圆肌,无一例发生骨折。既往报道的6例均行切开手术,本例患者在关节镜下完成手术治疗。术后效果除开放性损伤患者的外展活动受限外,其它全部闭合性损伤患者手术后功能恢复均较理想。结论肩关节后脱位合并巨大肩袖撕裂的临床表现多样,主要取决于受伤的严重程度及肩袖累及的范围。通常伴有肩关节囊韧带结构肱骨侧的撕裂伤。多源于高能量损伤,常见的发生机制为肩关节屈曲、内收、内旋位时遭受一个向后的暴力所致。对于出现该类损伤的患者早期MRI检查可以明确诊断。手术治疗通常可以获得较好的治疗效果,关节镜下亦可完成手术。

Objective To summarize mechanism, pathological features, clinical manifestation and diagnosis, and treatment of posterior shoulder dislocation complicated with massive rotator cuff tears. Methods We reported a patient with posterior shoulder dislocation complicated with massive rotator cuff tears who underwent arthroscopic surgery and had a good result. Pubmed, OVID, Springer, Science Direct, CNKI, Wanfang and VIP databases were searched for related arthicles published from January 1950 to February 2016. Results There were totally 7 cases of posterior shoulder dislocation complicated with massive rotator cuff tears, 6 of the cases were reported in 5 articles. The mean age was 35 years. All cases were caused by violence. Both supraspinatus and infraspinatus were injured in all cases. Subscapular muscle was injured in 4 out of 7 cases. Open injury was found in only one case and close injury in 6 cases. All patients underwent surgical treatments and had good outcomes. The patient reported in this article underwent arthroscopic surgery and also had good results. Conclusions Patients of posterior shoulder dislocation complicated with massive rotator cuff tears present various clinical manifestations and were difficult to diagnose. Violent injury is the most common cause. MRI is helpful for diagnosis. Surgical treatment is effective for this injury. Arthroscopic surgery is an ideal choice.