Mimura T, Mori K, Matsusue Y, Tanaka N, Nishi Y, Kobayashi M
Department of Orthopedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan.
J Orthop Surg (Hong Kong). 2006 Dec;14(3):336-9. doi: 10.1177/230949900601400321.
Traumatic posterior dislocation of the shoulder is frequently missed because of its rarity and the absence of characteristic symptoms. Several signs should be emphasised: an overlap of the humeral head and glenoid rim in a true anteroposterior view and the light-bulb sign in the anteroposterior view. To make an accurate and early diagnosis, use of multidirectional radiographs combined with computed tomography is recommended. Closed reduction was successfully performed under general anaesthesia using the DePalma method with slight modification--the lever principle--by pushing the medial side of the upper arm laterally to adduct the shoulder as far as possible. The dynamics of the lever principle make it a safer and more effective method of achieving a closed reduction of a posterior dislocation of the shoulder than the conventional method of solely pushing the humeral head anteriorly, especially in patients with locking of the glenohumeral joint and impression fractures.
创伤性肩关节后脱位因其罕见性及缺乏特征性症状而常被漏诊。应着重注意几个体征：在真正的前后位片上肱骨头与关节盂边缘重叠，以及前后位片上的灯泡征。为了进行准确的早期诊断，建议使用多方向X线片结合计算机断层扫描。在全身麻醉下，采用改良的德帕尔马方法（杠杆原理）成功进行了闭合复位，即通过将上臂内侧向外推以使肩关节尽可能内收。与单纯将肱骨头向前推的传统方法相比，杠杆原理的力学作用使其成为一种更安全、更有效的闭合复位肩关节后脱位的方法，尤其是对于存在盂肱关节锁定和压痕骨折的患者。
