肱骨近端骨折合并肩关节后脱位的诊疗策略

Diagnosis and treatment strategy for proximal humerus fractures combined with posterior shoulder dislocation

目的研究肱骨近端骨折合并肩关节后脱位的诊疗策略。方法回顾性分析自2016-12—2020-12诊治的6例肱骨近端骨折合并肩关节后脱位,先手法复位肩关节,再采用Philos钢板固定肱骨近端骨折块。比较术前与末次随访时的疼痛VAS评分。结果6例均顺利完成手术,随访时间12~24个月,平均17.5个月。未出现骨不愈合、肩关节再脱位及肩峰撞击等并发症。5例切口一期愈合,1例开放性损伤术后出现伤口红肿疼痛、渗液的现象,经酒精纱布湿敷换药2周后症状好转,4周后伤口愈合。末次随访时疼痛VAS评分较术前降低,差异有统计学意义(P<0.05)。末次随访时按肩关节功能UCLA评分评价疗效:优1例,良4例,差1例。结论肱骨近端骨折合并肩关节后脱位临床相对少见,肩关节后脱位易漏诊,且术中复位难度大,及时、全面的辅助检查与有效的治疗策略可显著改善预后。

ObjectiveTo study the diagnosis and treatment strategy for proximal humerus fractures combined with posterior shoulder dislocation.MethodsSix cases of proximal humerus fractures combined with posterior shoulder dislocation treated with manual repositioning of the shoulder joint followed by fixation of the proximal humerus fracture block with Philos plate from December 2016 to December 2020 were retrospectively analyzed.The pain VAS scores before surgery and at the last follow-up were compared.ResultsAll six cases were completed the surgery successfully,with a follow-up time of 12 to 24months,with a mean of 17.5 months.There were no complications such as bone non-union,shoulder re-dislocation and acromion impingement.Five cases had one-stage healing of the incision,while one case of open injury had postoperative redness,pain and oozing of the incision,which improved after 2 weeks of wet dressing change with alcohol gauze,and the incision healed after4 weeks.The pain VAS score at the last follow-up was lower than that before surgery,and the difference was statistically significant(P<0.05).The efficacy was evaluated by the UCLA score of shoulder function at the final follow-up:excellent in one case,good in four cases,and poor in one case.ConclusionProximal humerus fractures combined with posterior shoulder dislocation are relatively rare clinically,and posterior shoulder dislocation is easily missed and difficult to be reduced intraoperatively.Timely,comprehensive ancillary examinations and effective treatment strategy can significantly improve the prognosis.