Fekete Andras, Lumbreras Ruth, Navarro Evelio, Rodriguez-Chacon Luis
Servicio de Traumatología y Cirugía Ortopédica; Hospital Royo Villanova, Zaragoza, Spain.
Rev Fac Cien Med Univ Nac Cordoba. 2010;67(1):56-60.
The posterior instability of the shoulder only represents 4% of the shoulder instabilities. For the diagnosis, the antero-posterior, transtoracic and axilar radiographic projections are recommended. The inverted Hill-Sachs lesion is a fracture caused by compression of the antero-medial part of the humeral head during the posterior dislocation. Its treatment results, at least, controverted. Choosing the treatment of these lesions one of the main factors is the size of the defect in the humeral head. When it is smaller than 20%, the simple reduction usually is enough. Between 20-40%, we can opt for a transposition of the subescapular insertion to the bony defect (technique of MacLaughlin) or the anatomical reconstruction of the head by means of the fixation of an allograft. The transposition of the subescapular´s tendon carries a reduction of the internal rotation by medializing its insertion, for this reason, we opted for the anatomical reconstruction with allograft of femoral head that reestablishes the muscular balance. The shoulder artroplasty is elective when bony defects are bigger (>40-50 % of the articulation surface). We present the case of a 32 year-old patient, with the antecedent of convulsive crisis. Clinically he suffered intense pain with functional impotence and elastic limitation for the external rotation in left shoulder. The radiographic studies evidenced an instable posterior fracture-dislocation with inverted Hill-Sachs lesion associated that involved the 30% of the articular surface. The patient was surgically treated, opting for a reconstructive technique for humeral head. After six months, the range of motion is almost symmetrical with regard to the healthy shoulder, without any clinic of instability.
肩关节后向不稳定仅占肩关节不稳定的4%。对于诊断，建议采用前后位、经胸廓和腋位X线投影。反Hill-Sachs损伤是后脱位时肱骨头前内侧部分受压导致的骨折。其治疗效果至少存在争议。在选择这些损伤的治疗方法时，主要因素之一是肱骨头缺损的大小。当缺损小于20%时，单纯复位通常就足够了。当缺损在20%-40%之间时，我们可以选择将肩胛下肌止点转移至骨缺损处（MacLaughlin技术），或者通过同种异体骨固定进行肱骨头的解剖重建。肩胛下肌腱的转移会因其止点内移而导致内旋减少，因此，我们选择了同种异体股骨头解剖重建来恢复肌肉平衡。当骨缺损较大（>关节面的40%-50%）时，肩关节置换是一种选择。我们介绍了一名32岁患者的病例，该患者有惊厥发作史。临床上，他左肩部剧烈疼痛，功能丧失，外旋有弹性受限。影像学检查显示为不稳定的后骨折脱位，伴有反Hill-Sachs损伤，累及30%的关节面。该患者接受了手术治疗，选择了肱骨头重建技术。六个月后，患侧肩部活动范围与健侧几乎对称，无任何不稳定表现。
