急性肩关节后脱位合并巨大肩袖撕裂保守治疗一例报道

Conservative treatment of acute shoulder posterior dislocation combined with giant rotator cuff tear:a case report

急性创伤性肩关节后脱位发病率低,好发于青壮年男性,文献报道的发生率在1/10万左右[1]。据调查初次就诊时漏诊率可以高达60%~79%,平均延误诊断时间为8个月,有文献甚至报道了漏诊长达10年的肩关节后脱位[2-3]。虽然目前针对急性肩关节后脱位治疗策略缺乏有效的循证医学依据指导,但普遍的共识是肩关节后脱位应尽早复位,恢复肱骨头和肩胛盂之间正常关系[4]。

Objective To evaluate the efficacy of conservative treatment of acute traumatic posterior shoulder dislocation combined with giant rotator cuff tear in 1 case.Methods An acute posterior shoulder dislocation patient was referred to our trauma centre and underwent reduction.MRI showed posterior dislocation of the glenohumeral joint,compressed fracture of anterior medial part of the humeral head,massive tear of the rotator cuff involving the subscapularis,supraspinatus,infraspinatus.The teres minor was intact.CT scan 4 days after injury revealed that the congruence between the glenoid and humeral head was improved to be a subluxation.The patient had been immobilized by abduction brace in 20°external rotation position for 3 weeks and then fixed by shoulder sling as he was against any further surgical intervention.One month after injury,the patient began to move the joint passively.Active exercises were encouraged 2 months later.Subsequent CT scan and MRI after discharge demonstrated that the congruence of the joint returned to normal gradually.Although the MRI 3 months after injury showed that the massive rotator cuff tear developed to an unrepairable rotator cuff injury,he refused the surgery again.Results The patient was satisfied with conservative treatment results and returned to his former work.No obvious dysfunctions,except for the degenerated abduction strength,were observed.Conclusions Integrity of bone structure is the most important factor of glenohumeral joint instability.Conservative treatment results will be good if the area of humeral head compressed fracture is limited,but we must pay attention to the existence of rotator cuff injury in the acute traumatic posterior shoulder dislocation.Enlarging of the torn area and progressing of fatty infiltration in rotator cuff,narrowing of glenofumeral joint space need to be valued to both patients and doctors although the short-term outcomes of conservative treatment are satisfied.